Doctor knows best

One in a series of stories about patients that stand out for one reason or another. No names, no pack drill, no dates.


As a Community Responder, I get called out to many things (mostly chest pains where the patient clearly has forgotten where his or her chest is) but occasionally (on average 1 in 20 calls) it is a Cardiac Arrest.

A Cardiac Arrest is where the heart has stopped beating effectively (no pulse detected), as opposed to a heart attack, which is where most of the heart is working (beating) but part of it is being killed off by a clot.

Myself and a colleague had just cleared from a Job and were being sent to another. We had (at the time) pagers that sent through details of all jobs in the area, whether or not we were allocated to them. The details all included a Job code in the form 'number letter number'. (AMPDS for those that know). This job came through as a 6A1, which is a cardiac arrest - the most serious - and also showed the road, which I was just about to pass. I called in to Ambulance Control and was rapidly stood down from the job I was on my way to and reallocated to this. 30 seconds later I reached the door......


......only to be shown into a very much alive patient.

I started to get a history and it turns out that he'd jut been discharged from Hospital after receiving heart bypass surgery and was told to go home and take it easy. He did as anyone would do, given those instructions and took himself off to the pub for a smoke and some beers to celebrate.

Upon returning home, he had, indeed, gone into cardiac arrest, but had come round by the time that I, hotly followed by an Ambulance Solo Responder, arrived. As we started to get all this history, his heart stopped again. A quick precordial thump (not by me, I hasten to add) and the old ticker was running again....until it stopped.

It probably stopped and restarted 3 or 4 times by the time that an ambulance crew arrived to take him to hospital and we managed to get it going each time. Inbetween, he was perfectly awake, sat up and chatting away to us.

As far as I know he is still alive today, he certainly survived that day. Blokes (I'm sure this has to be a male trait) if your doctor tells you to take it easy as your heart has just been through hell and back, trust me. (S)he knows what he/she is talking about. Put your feet up, moderate exercise and lay off the stuff that earned you the bypass in the first place.

It's funny the things that stick out. Obviously, for the reasons above, the job itself sticks out, but I also remember him wearing a jacket, taking an interest in his appearance. Never mind his heart stopping from all those cigarettes, at least he looked presentable.


PS. Why do I go to a lot of patients with emphysema / COPD from years of smoking. They are on permanent Oxygen therapy, piped around the house for their benefit, catching their breath yet the rest of the household still see fit to puff away. Quite often I come home and shower as the air is so thick with tobacco fumes it gets everywhere. Spare a thought for your family member struggling to breathe in the next room.

What price for a life?

So, I've just completed a First Aid in Education questionnaire for some random student that found me online and found this gem during my research:

Average Secondary School spend per pupil in 2014 - £4,550
(http://www.sec-ed.co.uk/news/how-much-per-pupil-funding-will-your-school-get)

At the moment, pupils get no First Aid Training as part of the Curriculum.

If we assume 2 hours First Aid training per pupil per year: Say £100 per class of 30 to bring three Trainers in (at a max 1:12 ratio). That's just over £3 each. 0.06% of the budget. That's Peanuts. So why don't we do it?

How much of that £4,550 goes on, say, Religious Education? Surely £3 off that budget and 2 hours off the RE (RI, whatever) curriculum to save lives rather than souls would be money better spent?

3-year old dials 999

http://www.bbc.co.uk/news/uk-england-kent-38056677

4-year old Suzie calls 999 and saves mum's life

http://www.bbc.co.uk/programmes/p04d3ss8

If you have to do CPR on someone, it's more likely that it is someone that you know than someone you don't know. What more of an incentive do we need?

Can you learn First Aid from a video?

In 2013, the UK's Health and Safety Executive (HSE) - the Body that oversees Health and Safety in the Workplace - approved Blended learning when teaching First Aid.

What Blended learning means is that whilst some aspects of First Aid still need to be taught and practised face to face, a lot of it can be done remotely - for example by using video tutorials online.

On the face of it, this seems to be a strange move. First Aid is very much a practical skill. There is already a layman's fear of doing harm to a patient. To now say that you can try to save someone's life using techniques that you have watched online does not completely sit comfortably. How do you know that what you are doing is correct in terms of depth, speed, positioning and so on?

Perception vs Reality

Of course, it is not quite that bad. In practice, there are no completely online First Aid courses (Refreshers, yes. Initial courses, no). If you wish to obtain a (Emergency) First Aid at Work ( (E)FAW ) qualification, or one of the child / paediatric certificates you have to demonstrate practical skills at some point. However, a lot of the course groundwork can be undertaken online before the classroom session. The concepts and principles can be stepped through using videos and online question papers. Once the student can demonstrate a suitable level of understanding, (s)he can be signed off and allowed to attend the remainder of the course in a classroom.

What's in it for me?

The advantages of blended learning boil down to time and money.

Time

First Aid at Work is a three day course, Ofsted compliant Paediatric is two days. For smaller organisations it can be hard to release an employee for that length of time and still keep the Business going. With one day of online work, this can be carried out whilst at work so that the employee is still available for work-related matters. It's not often that an Employer will encourage employees to sit around watching videos on work time....

Money

As they saying goes, time is money. If you, as an employer send an employee away on a course, you still have to pay them for that day (plus expenses) but also possibly pay for cover. Agencies are not known for their altruism, staff drafted in will invariably cost more than regular staff.

Recording a Training video once and playing it many times is an economical way of delivering material and this is reflected in the cost of courses.  Whereas a typical course in a classroom will cost between £50 and £100 per person, ProTrainings (the certification Company that 4Minutes uses), for example, charges just £25 for the online part.

Precedent already set

Of course, First Aid is not the first to use blended training. Anyone that has taken a driving test in the last few years will know that there is now a Theory part that needs to be passed before the Practical. You still have to learn and take your test in a vehicle, thank goodness. At least for now. Once self-driving cars become more mainstream, I can see a day when there is a theory-only test. Interesting times ahead.

Any downsides?

Well, yes. As already mentioned, there is no feedback from the instructor if you are unsure and just watching someone perform CPR will not give you a feel for just how difficult it can be on a mannikin or a real person.

Summary

Blended learning and online-only learning is here to stay, like it or not. Whilst it has its place, 4Minute's stance is that all courses should have some face to face element when learning the major life-saving techniques. For underpinning knowledge and other parts of the course, then online at your own pace is almost as good as watching a trainer in person step through a series of Powerpoints.

What do you think?