As respiratory arrest may come all of a sudden, every second is extremely important. It’s not even a rare sight in our everyday lives. All it takes is an inhaled piece of food or a severe allergic reaction, and there you have it – respiratory arrest. Within a few minutes, circulatory arrest and loss of consciousness follow. That is why it is important to act as quickly as possible, to ensure airway patency and to call the emergency service immediately on the national emergency line 155. Read how an immediate first aid significantly increases the chance of survival in the story of paramedic Tomáš.
An emergency responder’s work comes with a large dose of adrenaline. Every workday is unique and filled with different emotions. Time is of the essence here, as every second counts. In serious cases, the paramedic team can be joined by a doctor, who is the only crew member with the authority to perform medical procedures or administer medication to a patient.
A sudden call
Tomáš has been with the emergency service for six years. His routine working day consists of calls to various traffic accidents, injuries, collapses or allergic reactions. As such, he’s used to hasty dispatches, but this sudden call to an unconscious patient was something special after all.
The two-member crew heads quickly to the car and sets out to the city center, where an older man has collapsed and isn't waking up. The stifling weather can really build up to such a state, and this case was no different. On the way to the patient, the crew is attributing their tasks and preparing all the necessary equipment.
Instructions en route
Suddenly we hear a message from the radio:
“Tomáš, Honza, this is the operations centre.”
“Operational, this is Tomáš, go ahead,”
follows the standard call response.
“Tomáš, this is operational, we’re commencing the emergency telephone-assisted CPR with the witnesses present,“
clarifies the operations centre.
“Operational, this is Tomáš, copy that. ETA at the scene within two minutes. Requesting a mobile medical unit, please.”
After evaluating the situation, the operations centre automatically directs the doctor to the scene.
“Tomáš, this is operational. The doctor has just disengaged from another call close to you. Redirecting him to you immediately.”
“Operational, this is Tomáš. Copy and thank you. Out.”
In the meantime, the crew is clarifying new information, as they already know how hectic the scene will be. Upon arrival at the location, Tomáš quickly distributes all the different pieces of equipment, of which there’s quite a lot. To perform the cardiopulmonary resuscitation (CPR) they need to bring a vital signs monitor with a built-in defibrillator, a suction pump, a small bag with an oxygen tank and two gear backpacks. In the ambulance, there’s also a bag valve mask (BVM) that serves for performing artificial respiration.
A race against time
Upon arrival, there’s no time to waste. Tomáš sprints to the patient, shouting quick instructions to his colleague:
“I’m starting the monitor, gonna kneel to his head, check the consciousness and breathing, then, if need be, I’ll start with chest compressions. Meanwhile, you stick defibrillation electrodes on his chest and get ready to take over the chest compressions after me.”
That, however, is only the beginning. In the meantime, they have to get the oxygen tank ready, attach the bag valve mask and secure the access to the patient’s venous system, so that the doctor can administer drugs, once he arrives.
The Pre-Arrival resuscitation
In the meantime, witnesses of the incident are performing effective CPR that they’ve been instructed to by the emergency line operator.
“Good job, everyone! You are doing great! Thank you for your help, we’ll take him over now,”
praises them one of the crew members.
Tomáš kneels down next to the patient’s head, checking whether respiratory arrest, unconsciousness and absence of a pulse in great arteries occur. Meanwhile, his colleague is sticking defibrillation electrodes on the patient’s chest, following the previous instructions word to word. Cooperation between team members is extremely important. While the defibrillator is charging, the chest compressions need to continue – they mustn’t stop, not even for those few seconds the defibrillator needs to charge. Then we hear the defibrillator’s alarm, indicating the machine is fully charged to administer the shock.
Tomáš checks the surroundings to make sure they can deliver the shock safely, without hurting anyone, while instructing the onlookers:
“Step aside, everyone, don’t touch the patient!”
Everything’s all right now, the coast is clear.
This was an instruction to his colleague to administer the shock and keep compressing the patient’s chest. Tomáš then initiates artificial ventilation using the bag valve mask, alternating compresses and ventilations in a 30:2 ratio.
The doctor arrives at the scene
As soon as the doctor arrives, he takes over the defibrillator and continues to deliver more defibrillation discharges. Then he secures the patient’s airways (performing the so-called intubation) and appoints the administration of necessary drugs. One more discharge – and the patient’s spontaneous blood circulation resumes, as his heart begins to beat again. The doctor gives clear instructions:
“Alright, gentlemen, standard post-resuscitation care, please. Saturation, capnography, blood pressure and a 12-lead ECG.”
Just as these tasks are completed and the doctor is done evaluating the information obtained, the whole team can prepare for the transfer of the patient to the ambulance and subsequent transport to the hospital.
First aid makes a difference
Meanwhile, Tomáš seeks the witness who started the CPR so promptly.
“Where’s the gentleman who did the chest compressions?”
The onlookers look around with uncertainty, as they don’t know, why the paramedic is searching for him. Tomáš realizes his initial query didn’t sound the most welcoming and continues in a much friendlier tone:
“Could you please tell him he did a really great job and saved that guy’s life for now?”
The onlookers, relieved a great deal, gesture towards the man, bringing him to the paramedics.
“Umm... that’s great, but anyone would’ve done that, wouldn’t they?” stammers the surprised man.
“Actually, we don’t see that very often, people are either clueless, or scared. But you really have done a great job and saved a human life right now. Thank you,” interjects the doctor.
Finally, Tomáš gets to take his soaked respirator off and rest for a while. Despite his job being so demanding, he’s pleased that today’s call ended well. As they set out to the hospital with their patient, the crew feels that all their hard work is really worth it. Every single day, around the clock, regardless of the weather the paramedics stand guard, so that instead of a ride to the hospital we can walk home on our own.
How to perform first aid
The provision of first aid is directly defined by law as the duty of every citizen, yet many people are afraid to provide it due to their lack of knowledge. Aside from knowing the proper procedure, it is necessary to keep your cool and avoid compromising yourself or anyone else. There are several types of first aid, depending on the situation at hand. In the case of unconsciousness, resuscitation consists of assuring airway patency, chest compressions and mouth-to-mouth resuscitation. The amateur resuscitation until the expected arrival of the emergency responders should be as follows:
Kneel down next to the unconscious person and check their reaction by shaking their shoulder. You also have to check whether the person is breathing.
To open their airways, tilt the head back slightly to lift the chin.
Watch the patient's reaction – whether they’re breathing freely and regularly (chest or abdomen rising, air coming out of the mouth or nose).
Next come chest compressions combined with mouth-to-mouth resuscitation. After 30 chest compressions, tilt the patient’s head back and give him 2 breaths of air into his lungs. If their chest won’t start to rise on its own, repeat until the arrival of the first responders. The most important thing is to continue with the chest compressions without interruption.
If you still aren’t sure what to do, you can turn to the emergency line operator, just as one of the heroes of our story did. However, resuscitation training must be carried out under the supervision of trained personnel. If the story inspired you and you would like to improve your first aid skills, you can enrol in the Red Cross Basic First Aid course. The Czech Red Cross conducts first aid training through its Regional Associations. These courses are intended for people of all ages. You never know when you'll find yourself in a situation where such knowledge will help save a person's life.
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The organization, founded by a real estate agency during the first wave of the COVID-19 pandemic, promotes the treatment of respiratory diseases in adults and children.
"We have supported various charitable projects as donors before,"
says Elena Jakubovič, founder of the real estate agency.
"This time we want to take it a step further and help Czech experts and hospitals in the long term."
Are you wondering how the real estate business relates to respiratory health? Elena Jakubovič and her team believe that a well-chosen house or apartment is a place where you can breathe with ease. And that's a feeling everyone should experience.