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.