Jul 27

To speak of it

Tag: Ambulance,Thrilling InstallmentKal @ 10:30 pm

Off the back of my recent post about stress responses, I found myself the only HCP amongst a host of volunteer first aiders recently. As a team we’d managed and packaged the sort of patient that gave me the shivers, the type of patient who clearly thinks that they’re dying, asks if they’re dying and I am unable to answer honestly.

Volunteer first aiders train for this sort of thing to an extent and I have to say that the group I found myself inadvertently leading were slick and proficient. They did exactly what I said when I said it and stopped when instructed to do so. They performed tasks that were far beyond what they anticipated on their first aid duty.

One held a young man’s head in her lap and told him he’d be fine, to just keep breathing and try to relax.

Another was improvising dressings from a first aid kit that was never intended to treat injuries such as this and she kept her cool when I snapped at her to “just open fucking everything”.

One guy was standing over us, handling the burgeoning crowd and organising marshalls to bring an ambulance immediately to our side.

And the fourth was opposite me, kneeling in mud and piss up to our thighs. She had her hands under mine, my fingers moulding and turning hers just so and pressing them down. She was pushing onto parts of a human body she’d probably never seen before, let alone held, hot and wet and twitching in her grasp.

Aware that five sets of eyes were expecting me to know exactly what to do, I wasn’t about to let on that I’d only ever seen that body part before on an autopsy table.

The patient shipped out on an ambulance, we reconvened as a group. Reactions were interesting. One was talkative, jabbering excitedly that she’d never seen multi-trauma. Her excitement lasted half an hour before she dissolved into embarrassed tears . The coordinator was grim-faced, though the water in his drinking bottle trembled when he lifted it. My equipment specialist was cold and analytical, asking pertinent questions about her performance and the patient’s prognosis. And the fourth was silent, fascinated by her shoes.

My brain swung into “bad job” mode, automatically playing the cards that we do at work, that just a few weeks ago I’d been analysing amongst my colleagues and myself. My arms swung out, clapping shoulders, touching arms and shaking hands. I dropped my paw around the shoulder of number four and she stiffened at my touch. The team fractured into a one, two, one formation.

I gave them a minute and cracked a joke; humour didn’t go down well and I realised that the rest of the group were not only unaware of how we decompress, but that they mistook my attempts to do so as crass and degrading.

And I, recognising the offence I was causing, backed away from the process and joined them in their brooding.

For me there was no reset. I did my best to warn people about adrenaline come-down, to ensure that they would get home safe and be looked after by friends. I tried to explain about questioning your own performance and realising that finding out the patient’s outcome may be impossible. I strove to make people see that what they’d done was amazing, had probably saved the young man’s life and encouraged them to take comfort from that thought.

It was only on the following evening, when I gathered with like minded friends, that I was able to hammer through the stages, to get my quota of physical contact, to make flippant remarks about a horrendous situation and to clink beer bottles together and agree that things had gone well.

We all have our rituals, developed through years of experience, trial and error.

Until you know what works, you have no choice but to have a go at decompressing through any means you can conceive.

Find a your system and employ it when you need it.

Just realise that it’s a personal or collegiate decision.

And it may not translate beyond borders.

14 Responses to “To speak of it”

  1. Win-Stone says:

    It really is all too easy to forget that we are all different. Each of us is shaped by our up-bringing, our past experiences, our knowledge, our surroundings and our present.

    Each and every one of us will react differently in any given situation, for the simple reason that each and every one of us is different.

    Sometimes a shared experience will bring out a shared bond and this will give rise to a shared feeling but, ultimately, the only thing that each can do is handle the mental aftermath in our own unique way.

    Beer, filthy jokes, raucous behaviour, sitting being maudlin, screaming, hitting a punchbag, getting drunk, writing a blog or going to Holland and getting drunk while eating schnitzel . They are all different, all individual and all as right as they are all wrong.

    It’s our differences which make us what we are.

    Viva le difference!

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  2. Stuart says:

    I saw more that weekend than I ever thought I would…it’s funny how it toys on your mind for far too long after

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  3. Lucy says:

    As usual, bang on target. All those differences are what makes life so interesting. Also, the first aiders probably do not deal with anything like the number of casualties you do so I would imagine their responses are very raw, whilst yours I suppose are more professionally honed. I imagine you would need humour and contact to get through doing your job every single day.

    Besides, being one who can be relied upon to find something inappropriately amusing, I suspect I would be more like you.

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  4. Karen says:

    When they have got over the shock of what they had to do, then they will probably realise what you were trying to do and why.
    Most people understand the need for black humour in situations like this but aren’t often in the situation themselves.

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  5. vinaigrette girl says:

    Two nonverbal things can help when you have people who don’t deal well with black humour: sit alongside, or crouch down so your face is below theirs, and just gently touch the side of their face or their forehead with the back of your hand, the way some adult did when you were a kid to take your temperature. It’s such a small thing to do, but using the back of your hand or fingers makes it unintrusive, but kind.

    The other is to go to the Oxford University WildCru website, learn the noises badgers make as mums to their cubs (a purr of sorts), or cub-to-cub purrs, and utter a few of those, gently, quietly, intimately, to the people who seem closed in and jump away from you. Just a little call, twice or thrice, very sotto voice, will do.

    Verbal doesn’t always work and sometimes we just need to be regrounded. I have a friend who uses badger talk to her child, who was born heroin-addicted to a different physical mother, and it’s amazing how well it works for him although he’s a bright, high-verbal child. i use it. the soft touch is from Theraplay, a technique which enables adults to reground as well helping kids.

    love,

    Vinaigrette Girl

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  6. Mike says:

    A bit of a shock to go from fainting grannies and wasp stings to a full blown multiple trauma. No wonder they found it difficult to cope.
    The hardened old stager tends to forget what it felt like the first time the shit really hit the fan and you can’t teach that sort of thing. Your group will be stronger for the experience, those that keep going that is.

    I know one young lad who had a young fit man die on him after a fun run. The old “unsuspected” heart problem. He was really shaken by it, “what could I have done that I didn’t do” self flagellation. He is now a first rate confident first aider and is applying to get into your line of work.

    I’m sure your lot will work their way through it, just like you had to.

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  7. Eileen says:

    It’s very easy to forget how the gallows humour that is very much part of many (though not all) people’s coping mechanism when they have been part of the health care field for a long time is a foreign language to others. One day, if they join the ranks, they too will look back and understand.
    Just wondered – do you know the outcome?

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  8. Martyn says:

    As others have said, it is different for each group/individual. I know in our centre that we have all levels and I know who I want to speak to after a bad job. I find the important things are to make training as realistic as possible and to make sure, as you did, that people know there are outlets for them to de-stress

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  9. Uphilldowndale says:

    For me as a lay person,my ESSENTIAL debrief came a few days later (following my efforts with no more than an out of date first aid certificate and a titchy first aid kit*, to try and save a life at the scene of a car accident) when the policeman (who shared the CPR with me) sought me out, came round had a cup of tea and chat. I’d gone from the adrenaline high of the incident, to a plummeting, ‘did I do it right? Could I have done more?’ low.
    The conversation we had, about the detail, that only we knew, and the fact that we had done everything that could be done, and as a lay person I’d done more than most would and competently.
    There was no way I could have known that, because the whole thing was so outside my experience.
    That cup of tea and a chat was a life changing event. Probably more so than the initial incident.
    * the first aid kit had a face shield in it. So glad it did. I now NEVER leave home without one.
    Go back and talk to them again Kal, they will be (IMHO) going through waves of emotions with it (and give ‘em a hug from me! They are stars.)

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  10. jean says:

    My first day in the ER I was appalled by the staffs behavior. They were joking, talking about going out for drinks, one was even eating a slice of pizza. All of this while a woman lie dying from a heart attack. I went home and cried. I couldn’t imagine going back. But I did. And I came to realize that to work in an ER you needed to have a sense of humor and a tough hide. In the end, working there was the best job for me.

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  11. Veronica says:

    I think it is easy to forget our ‘first time’. In common with others, I can remember hearing things and thinking ‘what a hard old bitch she is being to that old man’ or ‘how is that funny’? Whereas now I find myself saying what that hard old bitch said (making me a de facto old bitch!) or cracking a joke which is definitely on the black side. Whatever gets you through the night. Take care Kal and well done for helping them through their first one.

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  12. Compostwoman says:

    As a First Aider, who has stopped for several car accidents and has seen a few bad things as a result which I guess are not usually on the FA list…..

    I wish I had had you around to help or to talk to after.

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  13. Anon says:

    A bit slow off the mark in commenting, but that’s my workload for you.

    Anyway, I’ve been a first aider for almost 30 years now and have never yet been on a course that even touched on the comedown after dealing with an incident. First aiders can unexpectedly find themselves really deep in the shit, pushed way beyond the bounds of their envelope, seeing and doing things that even hardened professionals find difficult. Then, with the professionals on scene, in numbers and in control, the first aider gets up, disappears back into the crowd and goes on with “normal” life.

    No team for support. No debrief. No outlet. No understanding colleagues and friends.

    I’d go so far as to say most first aid trainers, in my experience, don’t expect their students to have to do more than slap on a plaster, flush an eye, put on a sling and perhaps organise for someone to dial 999. They certainly don’t expect that their students could find themselves in the midst of extremely traumatic events and they never touch on handling the consequences of that.

    My own first experience as a first aider came when I was 16. I’d had my certificate for less than a month. I was with a group of Scouts, walking along the top of a gully when the bank collapsed under one of the lads. He fell about 20 feet. He was both fortunate and unfortunate—after bouncing a couple of time he landed in a thicket of firethorn. It cushioned his fall, but he had thorns embedded all over his body including one in his eye. He also had a fractured wrist and numerous cuts.

    While a couple of Scouts went for the leaders, I clambered down and did what I could. I had to persuade the first two leaders who arrived to leave the injured Scout in place as they completely lost the plot—despite being much older than me. Fortunately, the third leader was a sensible, level-headed woman in her 50s who got rid of the other leaders and Scouts, sent someone for the emergency services and took charge of the first aid.

    Once the professionals arrived, I was sent back with the other Scouts. There was concern for the injured Scout but no one talked to me about what I’d experienced. I was just expected to get on with my camp chores. It’s been the same with incidents ever since.

    I’ve sat with my fingers in a motorcyclist’s thigh, holding an artery closed while waiting for help to come a considerably distance, sun blazing down, dust, blood and flies everywhere., chatting to the biker and waiting for what seemed like eternity. I’ve been swapped out for a paramedic, watched the rest of the ambulance team get the biker loaded and seen them disappear at speed. I’ve given my name and details to the police. Then I’ve hopped back in my company car, driven the 40 minutes back to the office, and had the boss ask where I”ve been and why I’m so filthy. After a quick wash and borrowing a clean shirt, I’ve found myself back at my desk and expected to catch up with my work.

    I’ve been having lunch in a cafe, seen someone arrest and collapse on the street outside, found they had no pulse and given CPR while I wait for the ambulance. I’ve had the patient suddenly jerk like a just-landed fish, wheeze, and subside again. I’ve discovered he had an intermitent, irregular pulse just as the ambulance arrived. I’ve done the handover, stepped back as the professionals did their bit and suddenly been reminded I haven’t paid for my lunch. I’ve then wandered back to the office, where I’ve been asked why I’m late back.

    It’s always been the same, whether I’ve been at work, at home, out shopping or just out and about. Something happens, help is needed and as a first aider, I’ve done what I could. Then I’ve just faded back into the crowd and gone back to doing all the normal, everyday stuff as if nothing out of the ordinary has just happened.

    The toughest incidents have been those where somebody has died while I’ve been with them, usually holding their hands and telling them I’m there for them, or where I’ve been at home and suddenly found myself dealing with life-threatening situations. How you get out of the wreckage of a car, give your details to the police, go home or go to work, and tell people “oh, I’ve just watched someone’s life ebb away”? How do you deal with rocketing from cosy domesticity to handling spinal injuries or severe head trauma and then back to cosy domesticity again?

    Preparing people for that sort of altered reality and its aftermath is not something that first aid courses acknowledge, much less deal with.

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  14. Failed EMT says:

    After 6 years service, i could compress no more, Ive recently been told its PTSD and have a long wait for treatment. The flash backs and nightmares are so real its like i’m there all over again, the worst is the infant whos staring into space and unresponsive, still in her car seat following a nasty RTC. I want it to stop, I cant take anymore. I’m just sorry i failed patents

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