Tuesday, 1 July 2008

The Crash Team

When somebody dies on a hospital ward, a “crash call” gets put out by a member of the ward staff. This comes through to the pagers of the members of the “crash team” who have only a couple of minutes or so to get to the ward and attempt to literally bring the dead person back to life again.

There is a definite order in which the various members of the crash team arrive at a cardiac arrest.

First there are the nurses due to the fact that they are actually on the ward when the person died and are often the people who put the crash call out in the first place. There’s usually two or three nurses there performing Basic Life Support (CPR) before the crash team arrives.

The first member of the crash team to get there is the Medical SHO. The Medical SHO is usually younger, quicker and keener than the other members and will try her best to organise a working airway, IV access, a heart monitor and give some emergency drugs.

The Medical SHO is quickly followed by the Medical FY1, who is even younger and fitter that the SHO, and would have been there first apart from the fact that he doesn’t want to get there, get scared by the situation and freeze with everyone looking at him and asking “What shall we do now, doctor?”

It takes about a minute or so for Advanced Life Support to get properly underway, and this is the moment when the Medical Registrar pitches up. The Medical Registrar is the leader of the crash team and she’ll have seen literally hundreds of these in her time. She’s got the knack of arriving early enough to potentially make a difference to the patient but late enough to allow the initial panic to die down and for everyone to slot into their roles so she can take over the overall running of the crash call.

Last to turn up is the anaesthetist. It seems that the anaesthetist’s role at a cardiac arrest is to turn up, sneer, suggest to the Medical Registrar that we should all stop now and then saunter off again. I used to think that this was because anaesthetists were lazy, but now I know that the reason we turn up last is because most of the time, cardiac arrests happen on general medical wards and in most hospitals, the general medical wards are nowhere near the operating theatres, which is where the anaesthetists hang out. The other reason is that the medics are perfectly capable of running the arrest without us, so we don’t bother making the long sprint from theatres to the medical ward (up to half a mile in some hospitals) and settle for a slow jog instead.

13 comments:

Anonymous said...

why do you need an anaesthetist at a crash call? 'scuse the ignorance...

Oliver Smith said...
This comment has been removed by the author.
Oliver Smith said...

I’m no expert and I’m sure that if I am wrong someone will correct me. I believe that an anaesthetist is needed at a crash call just in case that rare occasion happens that someone is successfully revived and requires to be anaesthetised for what ever reason (ICU etc.)

Just a complete stab in the dark

Interesting entry, as ever!

Dragonfly said...

Hehe.

Michael said...

The anaesthetist is generally the expert in airway management, which usually starts to get important if the resus runs on for any length of time.

Anonymous said...

Interesting.

IMHO I (as a post FRCA & MRCP) am usually the most senior person at the arrest. I was certainly the ONLY person to suggest Dantrolene for the young lad with MDMA OD with core temp 42+ and the only one to note the Complete Heart Block on the ECG, and sort out the trancutanous pacing on the 84 y.o.

Oh yes, and we're the ones to tell you to stop, when it really IS futile...

A advanced knowledge of physiology, pharmacology and critical care management counts for something!

Faith Walker said...

Cheers for the link- i feel so prvilaged!

At that crash call I wrote about the anaesthetist didn't even show up until about 20 minutes later muttering:

"Sorry, I was in theatre".

Deary me!

Anonymous said...

So Faith,

What precisely should the Anaesthetist do with the patient on the table, or the critically ill ITU patient, or the emergency section in Obs?

Sometimes we can't make it, that's why YOU should be able to crack on, and so I can follow my usually ABCD approach:

Arrive
Blame
Criticise
Disappear

TFIC!

AF said...

Easy anonymous...
I used to work on the Isle of Wight.
From the rehab ward (one end of the hospital), to one of the larger medical wards at the other end was about 1.1km, about 2/3 mile.
I remember that corridor all too well...

Anonymous said...

A cardiac arrest doesn't mean the patient "dies" and can't be "brought back to life."

They are at the tipping point. Their brain is still active!

Anonymous said...

Student Nurse

l'm only a 1st year student nurse and just done my first placement were l found myself doing CPR with the crush team around me Wow! l think you guys realy do a gr8 job ^^!

caroline said...

HI,
I have conducted a psychological experiment into the effects of exercise on cognition for my dissertation. I am interested in whether a doctors cognition may be affected if they have had to run to the scene of an emergency ( as I assume any member of a crash team would). I am sturggling to find information and definitions of specifically what a crash team is (I would need something that I could reference), and was just wondering if you could help me out at all?
All the best,
Caroline

Eleanor said...

You forgot the student nurse hiding in the corner crying because she has no idea what to do and is general scared by it all.
(I'm a first year nursing student who was witness to her first crash call last month)