Saving Lives – All in a normal day’s work?

GPs are rarely involved in direct ‘life-saving’, but it’s always helpful to know what to do in such situations, writes Michael O’Brien.

It must be a wonderful feeling to come in from a day’s work and be able to say: ‘I saved a life today’. It’s not something that GPs get the opportunity to do with any regularity. In reality, we are probably saving many lives every day, except there is no drama involved. By this I mean we are performing adequate management of chronic disease, timely intervention in treating infections, and prompt diagnosis and treatment of mental illness.

According to a study led by Prof Gerard Bury, which was an observational study from 426 general practices in Ireland looking at cardiac arrests in a general practice setting, some 26 patients owed their lives to the use of a defibrillator in general practice. This study came about because of the Merit project, which was established as a national training/equipment project on defibrillation in general practice. Over a 36-month period, there were 144 events. Some 88% of events were witnessed, 32% by general practice staff, and 58% of events occurred in the general practice or in the patient’s home. The GP was on the scene before the ambulance in 73% of cases, and 52% of the patients were defibrillated. An impressive 26 patients were discharged from hospital. That is an impressive one-fifth of these former ‘dead’ patients brought back to life as a result of this project. I am proud to be part of the Merit project and lucky enough that I have not had to use my defibrillator in my time with the project. I was provided around five years ago with a defibrillator and training in ACLS and ATLS over a two-day period. It is amazing with adequate training how confident you become in dealing with a very stressful life and death situation. But, with time and lack of retraining, one loses one’s confidence and skills in managing cardiac arrests. I completed a retraining course about two years ago and was afforded the opportunity to retrain last week. This training day was run by two GPs and a few advanced paramedics in UCD. The day was fantastic. We were given up-to-date information with regard to 30:2 compression: ventilation ratios, managing airways, recognizing cardiac rhythms and the use of cardiac drugs in an arrest situation. As GPs, we all had to lead a team of our colleagues and to make best use of their skills. Once again we were all energised and raring to go, ready for our next emergency. The knowledge and professionalism of the advanced paramedics was impressive and I know how important they are from my limited experience with them. I can recount two stories from my own life, one where I’ve never been as happy to see a paramedic, and the other where the patient was probably alive as a result of the paramedic saving him from the general public. The first case involved a six-week-old baby who was brought into the practice by her distraught mother after turning blue. Rule number one: phone the ambulance immediately. This was done and because the child was in bronchospasm, nebulisers and oxygen were started. Each second that ticked by seemed to last forever and when the paramedics arrived I was so relieved to see them. They immediately took charge of the situation and were out of the office within two minutes. That baby lived.

The second situation was after Ireland’s win over England in the Six Nations this year when myself and my brother (who is also a doctor) were leaving a hotel. As we were about to step into a taxi, we saw a man collapsed on the ground. It was impossible to say whether this was drink-related or an arrest situation. There was a crowd around this elderly gentleman and he was half lying in shrubbery. People were performing cardiac compressions, but no one seemed to know what they were doing and no one was in charge. It was absolute mayhem, with a crowd of well meaning but well-oiled bystanders. Again, remembering rule number one, I made sure an ambulance was called. Then I asked if anyone had checked for a pulse. Sure enough, when we checked he had a strong carotid pulse. Then I was in a dilemma. If he wasn’t alert, should we continue compressions or was he just inebriated? Thankfully, the fire brigade arrived and took charge. The first thing they did was pull him out of the shrubbery and put him in the middle of the road so he was accessible on all sides. They then ripped open his shirt, revealing a previous CABG scar. Obvious measures in hindsight but not something I had thought of. Myself and my brother let the professionals take over and retreated to our taxi, not sure whether we helped or hindered the situation. At the conclusion of our training course in UCD, we were reminded to check our AED and ensure that the battery was in perfect working order and the defibrillator pads were still in date. To my horror, the pads were about three years out-of-date and the battery was low. Can you imaging the extreme embarrassment and likely poor outcome if I had arrived at a cardiac arrest, pushing bystanders out of the way, only to find that my AED was not capable of shocking? This caused me to have a rethink of my policy of checking my equipment and emergency / anaphylactic medication, ensuring that I now perform it on a monthly basis. Congratulations and thanks to the forward thinkers who initiated the Merit project (www.ucd.webdirect.ie/merit.html) and keep it alive. It does save lives! Michael O’Brien is in practice in Leopardstown, Co. Dublin  Resuscitation, 2009; 80(11): 1244-7. Epub 2009 Aug 31. Article reprinted with the kind permission of Forum, Journal of the ICGP.