‘Can you hear me?’ Intense fight to save dying man
A COUPLE of nights before Paul and Caitlin found Ida in the middle of South Terrace, they were practising drills at their Alice Springs station when they were called to a one alpha.
A 54-year-old man was in cardiac arrest after being assaulted.
They sped to the house in one of the town's 13 aboriginal camps with lights flashing and sirens blaring. A second ambulance crew, as well as police, were also dispatched but the Intensive Care Paramedics were first on scene, finding dozens of people in the front yard.
"You can normally gauge from the people on scene what you're walking into and that was very much what we picked up on," Caitlin explained.
"It was right, this is the real deal."
Paul also sensed "terror and stress" when they arrived.
"Culturally, people do not want to be in the same room as a person who seems to be deceased so there was no one in the house, they were outside, so we moved past them," he added.
"Our comms are pretty good at picking up on when we might need police, so it's pretty standard that every cardiac arrest we turn up to in Alice, and pretty much throughout the Territory, police would have also been dispatched."
As the pair grabbed their advanced airway kit, the cardiac monitor and defibrillator - an expensive high tech piece of equipment that records a patient's vital signs - and rushed inside to the patient a bystander accused them of taking too long.
"In actual fact, our response time from the person making the call at the scene to us arriving there was four minutes," Caitlin said.
"But it's people's perception of that because they're now being presented with the worst possible day they have been able to imagine so far."
Despite the tension went into the house and found the man lying on his back on a mattress.
"We now need to perform … not knowing why this has happened, not knowing anything about the patient that might be useful to try to get clues as to why this has happened," said Paul.
"We are working in what can sometimes be hazardous conditions, squalid environments, dangerous environments or low-lit environments where we're doing this by torchlight.
"One of the strong aspects of skill sets again seen in emergency providers of different disciplines is not just the medical knowledge. It's scene management.
"It's crisis management. It's crisis communication."
They got straight into position - Caitlin, 28, knelt near his head and Paul to the man's side - and treated him in the confined space.
"Can you hear me?" Cailtin asked.
There was no response so she checked for other signs of life. There was none.
Then they launched into a complicated sequence of actions while making multiple but controlled decisions: What do we know about this person? What's their medical history? Are they a dialysis patient? What do we see?
Caitlin started compressions as soon as there no signs of life. She focused on his airway as she compressed his chest as they worked in unison.
Paul charged the defibrillator, Caitlin paused compressions, his heart rhythm was analysed and - pop - a shock was delivered before Paul resumed chest compressions.
(A defibrillator is used to deliver an electric shock to a person's heart in a bid to restart it.)
Paul then launched into a two-minute cycle of compressions while Caitlin established bag-ventilation and secured an intermediate airway by threading a tube down the patient's throat, all within 60 seconds. After the two-minute compression cycle they charged, analysed his condition on the monitor and shocked again.
Caitlin resumed chest compressions while Paul prepared to gain drug access to the man's upper arm while continuing to deliver ventilation.
Matt, a police officer, turned up.
"Are you happy to do chest compressions?" Paul asked him. He said yes and took over from Caitlin. His compressions were strong and fast and his assistance allowed Caitlin to start preparing to secure an advanced airway.
Paul had drug access locked-in as the backup paramedic crew arrived. Tasks were reallocated and paramedics began drawing up the resuscitation drugs and gaining additional drug access. Meanwhile, Matt continued his cycle of chest compressions.
When compressions reached two minutes, Paul again performed a charge on the patient.
They stood clear while Paul again interpreted the monitor and decided whether or not to give him another shock.
"Shocking!" he declared.
He told Matt to take a break and let another paramedic take the next cycle of compressions.
"Studies show that after two minutes of good CPR you start to fatigue which means you become less effective," Paul explained later.
He consolidated the information they'd gathered on the patient so far and briefed the team.
"All right, we have a cardiac arrest and at this time the cause is unknown with no clear history of events," he said.
"We have good access, I've given two shocks, and we need to continue working through all possible reversible causes."
Paul addressed one of the senior medics to try and discover more information on what exactly happened prior to ambulance arrival as well as any known medical history. He made decisions about drugs based on what they knew about the patient. If there was any suspicion the patient was on dialysis they'd choose different drugs.
One paramedic grabbed the drug kit and started drawing up more medications. Caitlin successfully secured the advanced airway using a state-of-the-art video scope.
Paul continued to co-ordinate the team while the drugs were drawn and given. Another two minutes passed.
Charging. Shock delivered.
Then officer Matt was back on the man's chest. Caitlin declared she was happy with the airway tube. They started pushing more drugs into the man in an attempt to change his heartbeat back into a regular rhythm.
"We were looking for a pulse but didn't have one so we were giving drugs to try to increase this, sort out fluids, and then we brought in the auto pulse which is the mechanical chest compression device," Paul said.
The device freed them up from performing manual chest compressions and allowed the crew to safely transport the patient to hospital. Caitlin remained focused on managing his airway and the crew gradually saw promising signs on the monitor.
Paul decided to take the man to hospital but getting out of the house would be tricky.
They had to lift and carry him out of the tight space, with electronic compressions continuing, to a stretcher at the back door. They then had to manoeuvre the stretcher across rough ground in the dark and into the ambulance while making sure his tubes and needles did not dislodge.
"The patient was now breathing periodically and this was occurring because our CPR was so good at providing oxygen to the brain," Cailtin said.
"However the heart was still not strong enough at that time to sustain pulses so we had to keep compressing.
"We ended up, quite unusually, delivering 10 shocks. That's a lot.
"There were a number of adjustments including alternate pad positions and drug choices made before we regained a stable heart rhythm."
They maintained the man's heartbeat on the short trip to hospital but, sadly, he later died.
"The monitor gave us a lot of positive information initially," said Caitlin.
"Our patient was warm to touch so still had a temperature within normal ranges and our monitor first displayed a shockable rhythm so that's an optimistic sign.
"Normally we may have had a more favourable outcome in similar circumstances however, a long list of chronic disease issues were later revealed which meant in reality chances of survival were very slim.
"We just didn't know that at the time and naturally we gave it our all."
Days later we returned to the scene but the house was abandoned.
"In Aboriginal culture people don't want to be the last person to see a relative alive in some settings because they may be blamed or receive payback," said Caitlin.
"Some Aboriginal people believe that the last person to touch the body is responsible for them and ultimately the death.
"They may also be reluctant to go back into a house where someone has passed away because they believe there will be bad spirits."
Paul was reflective.
"The resus attempt, management, intervention and everything else, on debrief and reflection was actually very good," he said.
"We didn't run into any problems that we couldn't manage.
"Direct police assistance was highly valued. Our team communication was excellent.
"We addressed everything that we possibly could do and our decisions, even in hindsight, were appropriate."
Paul said his decision to transport the patient to hospital, and to a higher level of care, was also "the right call" under the circumstances.
"We had access to additional support that might have made a difference," he added.
"Although unfortunately, as is often the case, the end outcome was unsuccessful in that the patient did not survive … from a technical and team perspective, all went very well and extremely smoothly because we were working to a preconceived, practised plan, that was flexible enough to adapt to the changing situations."
These are the untold stories of courage, compassion, dedication, resilience and inspiration of a caring group of remarkable and selfless first-responders in two of the toughest towns in Australia.