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From the frontline: Good systems save lives
On #StartAHeart day, Freddie Ivin, a call handler for the NHS 111 service in Norfolk, explains the vital training role NHS Digital plays in helping call handlers deal with CPR calls, and Gina Gill, at the Yorkshire Ambulance Service, describes the impact of a call she received about a man who had stopped breathing.
16 October 2020
As an emergency call handler, the annual CPR training that the NHS Pathways team at NHS Digital provides, is invaluable.
During our initial training, it’s explained to us in detail what to expect from a CPR call. These calls can be unpredictable, but the training explains to us what to look for and which pathway to follow.
The NHS Pathways system offers clear and concise instructions in a step by step flow, so there is no room for confusion for either the call handler or the caller.
We also receive hands on training on CPR with mannequins which gives us an idea of how tiring it can be. This makes us realise how important it is to advise others with the patient to take over if that is possible.
I work for IC24 which stands for Integrated Care 24 which is the trust that runs the NHS 111 service for Norfolk, south and mid Essex and East Kent. We have a metronome that appears automatically and begins counting at the steady 1,2,3,4 rhythm, allowing the call handler to jump into a consistent rhythm with the caller.
Any interruption during the call to answer questions or speak to others at the scene can throw this rhythm off but with the metronome counting repeatedly on the screen, this is easily remedied.
It’s also easy for the caller to get tired as you need to keep counting the compressions out loud and encourage the caller at the same time.
I tend to get an adrenaline rush when the call begins, so it takes time for my mind and body to settle down again.
I personally find it helpful to stand up and perform the compressions on the table in front of me so I can gauge the rhythm and effectiveness of the compressions being done. To keep the caller performing the compressions, we advise being on loudspeaker so the caller has both hands to perform and we can hear the rhythm of the compressions clearly.
After every CPR call, I take a couple of minutes to compose myself and get back into taking more regular calls. I tend to get an adrenaline rush when the call begins, so it takes time for my mind and body to settle down again.
Depending on the type of call you receive dictates how you feel afterwards. However, the process we follow is exactly the same. We need to keep people on the phone and we need to keep them calm.
It can be tiring and I would advise anyone to take a short comfort break after a CPR call as the ramifications may not hit you until later on. I will sometimes talk the call through with the manager or a clinician for reassurance.
One thing I do after a call is not dwell on it and I do not take it home with me. I would say this is easier said than done for some people, so it’s best to speak to a manager if this is happening to them.
No CPR call is the same. It all depends on the patient’s age, the reason for their symptoms and if anyone is with them.
I definitely feel supported and confident in what I’m doing. I feel safe in the knowledge that if I need someone to take over the call, they can do.
I feel privileged to have such a clear and easy system to follow.
Gina Gill describes a recent personal experience of a CPR call whilst working as a recently qualified NHS 111 health advisor at the Yorkshire Ambulance Service.
Our 111 service usually handles general health enquiries and non-urgent health care treatment, helping thousands of people find the best way to access the NHS.
CPR calls are therefore a rare occurrence. Many of my colleagues have worked at the service for years and have never taken a CPR call. So, one day, when I received a call from someone saying a man was not waking up and had stopped breathing, it was a massive shock.
The call was made by a woman who on visiting a friend found him lying on the floor in his home, seemingly unconscious. The woman didn’t seem too panicked at first and didn’t mention he was on the ground until I started the assessment.
I asked the caller to try and wake him but after shaking him, she was unable to do so. It quickly became clear he wasn’t breathing and as soon as you hear those words, you know exactly what to do.
I immediately arranged for an ambulance to attend the scene and then asked the caller to put her phone on the floor so she had her hands free to start CPR. We started counting the compressions together. I had to keep encouraging the caller to keep going even though it was tiring. It felt like time was moving very slowly but also at super speed.
The call came through during my fifth week of training, so I was still learning about the way the NHS Pathways system operates and how to navigate the many facets the service provides.
Thankfully, I was able to immediately recognise the signs we had been taught in our training about unconsciousness and abnormal breathing, allowing me to quickly arrange help.
The NHS Pathways system that guides us through every call gave me incredibly clear instructions that I had to relay to the caller. Alongside this, I used my recent CPR training from the Yorkshire Ambulance Service to help me describe each step.
I had a clinician and an experienced call handler by my side who could have stepped in at any moment if I became overwhelmed by the task in hand.
I knew the ambulance crew would be travelling as fast as possible to the scene, but I was constantly aware that every second this person went without defibrillation and emergency treatment, reduced their chances of survival.
The whole situation didn’t really hit me until I heard the ambulance crew arrive. They took over the life support and began defibrillation.
I had just witnessed someone on the line between life and death and this call made me step back and realise my job here and the hard work of the caller, along with the support from emergency services, is something that can really change lives.