Ambulance stories (31)

Resuscitation exaggeration.

During my 22 years of operational duties in the London Ambulance Service, I attended a rough average of  5-6 cardiac arrest calls in a 7-shift period; slightly less than one a day. It was not unusual to attend four in one day, then none for three days after. Sometimes, these were following injury, so were hopeless to begin with, but usually they involved elderly people, who had died suddenly, as a result of heart problems and strokes. Occasionally, there would be infant cot deaths, or juvenile drownings, and other less common causes included in this number, but they were rare. My length of service meant that I worked for approximately 1,000 weeks, allowing for holidays and sickness. If I multiply this, by a very conservative estimate, of  just under four per week, then we arrive at a total of 3,750 attempts at resuscitation, during my time there.

At the time, attitudes and training were changing fast. In the early 1980’s, defibrillators appeared for the first time, and intubation became widely practiced. Cardiac compressions replaced older methods, and automatic inflators, using oxygen, were in widespread use; as well as the bag and mask combination, replacing mouth-to-mouth, for professional crews. Training on realistic dummies, with simulated conditions, was the norm, as early as 1979; and a great deal of emphasis was beginning to be placed on fast removal to hospital, whilst still continuing a full resuscitation protocol. Indeed, any patient who had been in a state of cardiac arrest for as long as thirty minutes, prior to the arrival of the ambulance, still qualified for a full attempt at revival by these methods.

Once drugs became approved, Atropine and Adrenaline would be administered via the endotracheal tube, and this was believed to elevate the chances of recovery, or at least a return to a normal heart rhythm. The whole procedure was constantly re-assessed, with the ratio of compressions to inflations regularly revised, for optimum efficiency. Staff would be trained every year, to refresh their skills, and would receive regular updates on the latest best practice. Performance figures were supplied by the LAS, showing a great improvement in successful resuscitation, and as a result, automatic, virtually foolproof defibrillators were put onto all operational vehicles, and every member of staff trained in their use.

By this time, there were also many popular TV programmes covering medical issues, both fictional, and documentary. In these shows, it was common to see many successful resuscitations, and great results from defibrillation. As if by magic, people admitted with terrible illnesses, would suffer a cardiac arrest, be shocked by the de-fib, open their eyes, and be ready to go home by the end of the one hour programme. As a result of this, and the unreliable figures supplied by the Department of Health, the expectations of the General Public became increasingly unrealistic; to the degree that normal people, with no medical training or experience, refused to accept that their friends or relatives could not be resuscitated. To pacify this attitude, ambulance staff took more and more dead people into hospital, on the pretext of resuscitating them, only to find that hospital staff started to refuse to accept them into the department, and would certify them dead in the back of the vehicle.

This general misconception continues to this day, and the expectations are undiminished, with published figures continuing to show an annual increase in the success of modern resuscitation techniques. Sadly, this is a great charade. Admission to an Intensive Care Unit, may be regarded as a success for the ambulance crew concerned. However, depending on the age of the patient, this is merely a staging area, as options for organ donations are explored, and the patient is kept on a ventilator. Alternatively, relatives may be opposed to turning off life support, and the situation drags on, until the hospital are prepared to intercede. It is incredibly rare for a patient to recover from resuscitation, wake up, discuss their options, and perhaps be offered cardiac surgery, or treatment for other conditions, such as a major stroke.

In all the time I worked in London, with the aforementioned 3,750 attempts at a full resuscitation procedure, I can honestly say that I can only recall two patients who survived. One of these arrested in front of myself and my colleague, and the other on an underground train, and by complete chance, opposite four doctors who were on their way to a conference. As both arrests were ‘witnessed’, and the treatment immediate, their outcome was favourable.

As we used to always say, during my years in London. ‘Dead is dead’. Everything else is just advertising and self-promotion.

20 thoughts on “Ambulance stories (31)

  1. True words Pete your numbers would be in line with the nuber I attended in London (NZ seemed less). I remember 3 cot deaths one straight after the other, and in all my years I beleive only 5 resusciated patients survived to leave hospital 4 were witnessed by myself the one other was right out the box of all I attended I would not have expected such a positive result. Cardiac arrest due to trauma this is where the films have it all wrong.

    Liked by 1 person

    1. If you ask any EMT for the truth, I’m sure they would tell you the same thing, Liz. The statistics are scandalously manipulated, so as not to distress the public I presume.
      Best wishes, Pete.

      Liked by 1 person

    1. TV shows/films have a lot to answer for. I know they all pay ‘techical advisers’ for medical scenes, and it seems to me they are wasting their money if they think they are getting accurate advice.
      Best wishes, Pete.

      Liked by 1 person

  2. Yes, all those wonderful television shows cause such unrealistic expectations. In the work I did it was not nearly such a serious issue because no lives were at stake. It must be really frustrating having to deal with so much bullshit when there are serious cases that need help.

    Liked by 1 person

    1. It distresses relatives and bystanders when nothing can be done. They are fed propaganda about defibrillators, and expect their family member or friend to be able to sit up and talk to them. At the very least, it is irresponsible, Carolyn.
      Best wishes, Pete.

      Liked by 1 person

  3. Pete, again, you are bravely saying what many ex ambos were too scared to comment on – even to each other. I was 10 years part time & 5 years full time ambulanceman in NZ and 5 years full time in London + a short stint in Los Angeles. In all that time I saw only one in full arrest reach hospital resuscitated.
    The ingredient needed is instant CPR & an ambulance that can arrive in a few minutes. Anywhere in the world a rapid response can be 10 minutes plus the time control handle the call & the time it takes getting from the arrival up the stairs to the event.
    It sounds like the advent of AEDs in public places etc has helped as has turning fire trucks out as first responders. Wellington Free Ambulance claim 28% of their out of hospital cardiac arrests reach hospital alive. I’d be surprised with that and would like to see the criteria of the data.
    But I think where Pete is heading, and certainly it has been my view, there are districts with only 1 or 2 ambulances and all resources are tied up flogging a dead horse whilst other live jobs wait or go without. Then there is the quality of life issue. I certainly wouldn’t like to be resuscitated.

    Liked by 1 person

    1. Thanks, Gavin. Arriving at the hospital wiith a limited cardiac output is no indication of successful resuscitation or patient survival, as you know all too well. When I see claims of 15-30% success rates for cardiac arrest patients, I conclude they were not actually dead in the first place.
      Best wishes, Pete.


  4. There seems to be a fear of telling the truth. It is a bonus if anybody who arrests survives to tell the tale. As you say, it tends to be in the best circumstances and with a pretty rapid response, and even then, it does depend on the underlying causes. A consultant I worked arrested in the canteen of a psychiatric hospital and died, despite a colleague by his side attempting resus and a pretty quick response (mind you, there was no crash team, as this was a psychiatric hospital). Thanks, Pete. It is similar to the answer I gave to a questionnaire from the Royal College of Psychiatrists about suicide. Yes, there are things we can do, but we shouldn’t promise that we will be able to avoid all suicides.

    Liked by 2 people

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  6. Yes dead really is dead, I tried explaining to someone the other day that resuscitation is like playing the lottery. More often then not you will lose. Families don’t understand that a lot of the time underlying conditions prevent us from bringing back dead relatives.


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