Pre-Hospital Event Health: Rapid Medical Intervention – Saves Lives.
February 1, 2019
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Incoming Train: CARDIAC ARREST

Case Study

Colbrow Medics provides Metro Trains First Aid Medics to several inner-city Melbourne stations, including Caulfield, North Melbourne, Clifton Hill, Flinders St, Richmond and Flagstaff.  On Thursday 5 September 2019 at 0820hrs, whilst on duty at his regular station: Caulfield, Jim Hall had a call over the radio from Metrol that a passenger had collapsed and CPR was being provided by two young passengers.  The patient collapsed at Carnegie station and the decision was made by one of the first aiders, in conjunction with the driver, to immediately depart for Caulfield due to the fact that Colbrow Medics allocates a Metro Medic, equipped with an automated external defibrillator (AED), oxygen unit, first aid trauma kit and wheelchair. Time was critical and they made the decision to leave Carnegie and head to the next station (Caulfield) rather than wait for Ambulance Paramedics.

 

PHx- Patient History

  • Healthy 64 yo male heading into the city
  • Incident not witnessed by Medic: Pt appeared to have fainted but soon became apparent that the situation was dire
  • No known medications
  • No known allergies

O/A – On Arrival

  • 0823hrs – danger assessment: nil
  • Pt lying on floor of train
  • 2 passengers performing CPR

O/E – On Examination

Initial Eyeball Assessment

  • Pt is pale, unconscious, not breathing, nil pulse
Vital Signs:

RR: 0
HR: 0
BP: N/A
GCS: 3
Skin: pale / cold

 

Rx – Treatment

  • Immediately attached automated external defibrillator (AED)
  • STAND BACK, ANALYSING: SHOCK ADVISED.
  • Recommenced CPR
  • Requested portable oxygen therapy unit
  • STAND BACK, ANALYSING: SHOCK ADVISED.
  • Recommenced CPR
  • Attached bag and valve mask (BVM) to patient, commenced counting compressions
  • STAND BACK, ANALYSING: SHOCK ADVISED.
  • Recommenced CPR with patient being provided with oxygen via the BVM (two breaths per 30 compressions)
  • STAND BACK, ANALYSING: SHOCK ADVISED.
  • Recommenced CPR
  • STAND BACK, ANALYSING: SHOCK NOT ADVISED.
  • Ambulance Paramedics arrived on-scene
  • Pt now breathing with slight eye movement
  • Handover to Paramedics

 

Outcome

Ambulance Victoria Paramedics arrived within 9 minutes of call-out – Code 1. Handover completed and assisted Paramedics with moving patient to the ambulance. Ambulance departed at 0901hrs.  Patient was transported to the Alfred Hospital, had three stents placed and received neuro-protective interventions in intensive care (ICU). He remained intubated and ventilated for a few days and was discharged almost two weeks later.  Debriefed with the Life Savers, Megan, Annie and also Kirsty who were all very relieved and elated that the patient made a recovery in their care. The patient has made a full recovery and is heading back to work mid-October! A excellent example of early access, early intervention and early defibrillation: saves lives.

Life Savers: Jim, pictured with Megan (right) and Annie (left)

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