ANATOMY OF A CPR CALL WITH BARRIERS

Redacted Call Transcript

Craig Sturgess of Welsh Ambulance Services NHS Trust (Wales, U.K.) received this CPR call in 2016. He encountered and  expertly managed over 50 barriers on this nearly 17-minute call.

He naturally balanced providing care and comfort to the patient, the patient’s wife, and their neighbors—never placing the care of one over the care of all. In addition to the training he had received, this balancing act demonstrated an innate ability to provide brilliant and compassionate situational awareness.

Faced with barriers that did not have specific, ready solutions from either his training or pre-arrival instructions, he created ways to keep the caller engaged in overcoming these barriers cooperatively. As each barrier presented, he patiently  and kindly offered solutions until something worked. Read this transcript to explore his innovative solutions, which demonstrate a gold standard of customer care.

Tragically in January 2018, Craig passed away suddenly at home. Prior to his death, we had begun working with him on this  project, intending to help other emergency medical dispatchers identify and manage barriers encountered on CPR calls. We appreciate the support and cooperation of Welsh Ambulance Services NHS Trust and his family to complete this project.

TRANSCRIPT (times from original call)

0:00
Craig: Ambulance service, what’s the full address of your emergency please?
Wife: Umm, my husband is just collapsed in the bathroom. 

0:07
Craig: Okay, what’s the full address of the emergency please?

0:26
Craig: Okay, tell me exactly what’s happened.
Wife: Well my husband had a fall a week ago. I’m waiting for the doctor to come today. 

0:33
Craig: Right, what’s happened to him now?
Wife: I was just washing him to put him back in bed and his legs just collapsed, and he’s lying on the bathroom floor. He’s been unable to take his inhaler. He’s got COPD.

0:47
Craig: Okay, are you with your husband now?
Wife: I’m in, I’m in, just in the room next door.

0:51
Craig: How old is your husband?
Wife: 76.

0:54
Craig: Is he awake?
Wife: No.

0:58
Craig: Is he breathing?
Wife: Yes, just.

1:01
Craig: “Just” is it?
Wife: Yeah, it’s just he gulps every so often.

1:10
Craig: Okay. Pause. Right, I’m organizing help for you now. Stay on the line. I will tell you exactly what to do next.
Wife: Okay.

1:15
Craig: Okay, are you able to take the phone to him?
Wife: No, I’m on a different line. I’m not on the … I’m on the, the sort of uh …

1:22
Craig: Can you, can you go and pick up … have you got a cordless phone there?
Wife: Yes, I have.

1:26
Craig: Can you pick that up for me?
Wife: Yes, I can. Just a sec.

1:29
Craig: Thank you.

1:40
Craig: Is heard whispering, “Come on, come on, come on, come on.”

1:47
Wife: Can you hear me?

1:48
Craig: Yes, I can. Okay, can you make your way to him for me? Let me know when you’re by his side.
Wife: Yes, I can. Right.

1:55

Craig: Okay, listen carefully.
Wife: Yes?

1:57
Craig: Lay him flat on his back on the ground.
Wife: Yes.

2:01
Craig: And remove any pillows.
Wife: Right, well he is flat on the ground.

2:11
Craig: Okay, what position is he in?
Wife: He’s in, he’s almost in the recovery position.

2:15
Craig: Right. Okay, is he facing away from you?
Wife: Yes, he is.

2:19
Craig: Okay, what I want you to do, I want you to grab the knee closest to you and the arm closest to you. And I want you to pull them up and toward you. And that should roll him onto his back. Can you try that for me?
Wife: I don’t know whether … oh, he’s moved just a little bit, just …

2:33
Craig: Put the phone down if you need to do it, okay?
Wife: Puts phone down.

2:55
Craig: Okay, listen to me now. Is he flat on his back?
Wife: No, I can’t get him on his back. I’m 75, and I’m not very strong.

3:02
Craig: Okay, listen to me, I am going to help you now, okay? Are you able to get on the other side of him?
Wife: No, because he’s fallen with his head against the toilet.

3:10
Craig: Okay, try and get him as flat on his back as possible for me.

3:17
Craig: Try and get him flat on his back as possible for me, okay?
Wife: Okay. Indiscernible. He’s dead weight. I can’t do it. I can’t do it. And I think he’s died.

3:58
Craig: All right. Listen to me very carefully now, okay?
Wife: All right.

4:02
Craig: Listen carefully, okay?
Wife: All right.

4:06
Craig: All right. There’s another way to do this, okay?
Wife: Well, I can’t move him. I just can’t.

4:12
Craig: Okay, listen to me now. What I want you to do, I want you to leave the phone next to him by his head so I can speak to him. I want you to go and knock a neighbor either side and see if you can get some help.
Wife: No, they’ve gone to work …

4:27
Craig: Just knock anybody in the street, a passerby or anything like that. Can you do it now for me? Leave the door wide open. We are coming as quickly as we possibly can.
Wife: Okay.

4:37
Craig: Okay? Just try and get somebody to help you. When you come back, pick the phone straight back up.
Wife: Puts phone down.

4:55-7:11
Craig: Sir, if you can hear me we are coming as quickly as we can for you. Okay? All right. We are coming as quickly as we can. And we’ve got the best help coming to you, okay. We’re coming as quickly as we can. All right, sir. If you can hear me,
we are coming. Sir, we’ve got the best help coming to you, okay? All right. Your wife will be right back now. She’s coming as quickly as she can.

7:18
Craig: Hello? Is anybody there? Hello?
Neighbor: Hello?

7:29
Craig: Hello. Hello. Who am I speaking to?
Neighbor: Is this the emergency services?

7:32
Craig: Yes, it is the ambulance service.
Neighbor: I’m the next door neighbor.

7:34
Craig: All right. Listen to me very carefully. I need you to lay him flat on his back, okay?
Neighbor: Flat on his back. Okay, bear me a second. I’m going to pass over to my grandfather, okay?

7:42
Craig: Okay.
Neighbor’s Grandfather: Hello?

7:44
Craig: Hello there sir, let me know when she’s got him flat on his back, okay?
Neighbor’s Grandfather: Okay.
Wife: He’s still on his side, see?
Bystanders speaking amongst themselves

8:22
Neighbor: Hi. Right. We’ve got him on his back now.

8:23
Craig: Right. Place your hand on his forehead, the other hand under his neck, and tilt his head back.
Neighbor: Right. Okay, bear me a second. We’re just trying to get him …
Can hear wife say “he’s away, he’s not” then neighbor say to her “It’s fine. It’s okay, darling.”

8:35
Craig: What I want you to do for me once you’ve done this, when you’ve tilted his head back, put your ear next to his mouth and tell me if you feel or hear any breathing.
Neighbor: Okay, bear me a second. Grandfather, put your hand under his head, hand on his forehead, and one hand under his neck. Tilt his head back. To tilt to the back. And I’m just going to listen to his breathing. Okay? Okay, granddad, you up. No, I can’t feel anything.

8:58
Craig: Okay, listen to me very carefully. I am going to tell you how to do resuscitation.
Neighbor: Okay, grandad, do you want to do resuscitation, or do you want me to do it?

9:04
Craig: What you want to do, right, is just place the heel of your hand on the breastbone (in the center of the chest) right between the nipples. Put the other hand on top of that hand.
Neighbor: He has to be absolutely flat on his back, okay?

9:16
Craig: Yes, he’s flat on his back.
Neighbor: He’s just stuck in the bathroom. So we are just going to try to move him, in a second be with you.

9:24
Craig: Just try to pull him by his legs or anything like that. Just get him as flat as possible, okay?
Neighbor: Okay, so you want to put the heel to the breastbone. Heel of your hand to the breastbone.

9:30
Craig: In the center of the chest, right between the nipples.
Neighbor: Between the nipples. Yep, we’ve got that.

9:34
Craig: Put the other hand on top of that hand.
Neighbor: Right. Yeah.

9:37
Craig: Pump the chest hard and fast, at least twice per second.
Neighbor: At least twice per second.

9:42
Craig: And 2 inches deep.
Neighbor: 2 inches deep. Yep, he’s doing that, yeah.

9:45
Craig: Tell him to let the chest come all the way up between the pumps.
Neighbor: All the way up between the pumps. Let the chest come all the way up.

9:49
Craig: We are going to do this 600 times until the help can take over.
Neighbor: Yep.

9:51
Craig: Okay, I want you to count out loud so I can count with you.
Neighbor: Okay. So, right. Granddad, you go on the phone, and I am going to take over and do that. Bear me a sec, I am going to pass you to my grandfather.
Craig: Okay, thank you.
Neighbor’s Grandfather: Hello?

10:15
Craig: Hello there, sir. Can you count out the compressions for me, please?
Neighbor’s Grandfather: 1, 2, 3, 4, 5, 6 …

10:20
Craig: That’s it. Tell her to keep doing that now at that speed, okay? Tell her not to stop now until the help can take over. We are coming as quickly as we can.
Neighbor’s Grandfather: Okay.

10:32
Craig: All right. Do you want to ask the wife to maybe to step out of the room, just obviously because she is a little bit upset? Okay? All right.
Neighbor’s Grandfather: He said will you like to step out of the room because it is going to stress you out.

10:46
Craig: If she wants to stay with him, that’s perfectly fine. Just thinking of her, that’s all.
Neighbor’s Grandfather: She wants to stay with him.

10:50
Craig: That’s perfectly fine, sir. Just tell her to keep going at that pace now, okay? 1, 2, 3, 4. 1, 2, 3, 4. 1, 2, 3, 4.
Neighbor’s Grandfather: 1, 2, 3, 4. 1, 2, 3, 4. 1, 2… that’s it, she’s got it then.

11:03
Craig: That’s it. Keep going. Tell her she is giving him the best possible chance until the ambulance arrives.
Neighbor’s Grandfather: Okay, I’ll change you over in a minute. You’re doing right. That’s the right speed. We have to do it until the ambulance can arrive.

11:24
Craig: They are coming as quickly as they can.
Conversation between bystanders.

12:02
Craig: Sir, I’m still here sir, okay, just to let you know.
More conversation between bystanders.
Neighbor: Right. I’ve just handed it over for a minute.

13:19
Craig: Okay, that’s fine. Just tell him go, it needs to be the pace of 1, 2, 3, 4. 1, 2, 3, 4. Just tell him to keep up that speed, okay?
Neighbor: Keep that pace up.

13:30
Craig: All right, you all are doing really well there. Listen, you are keeping him going until the ambulance can arrive.  Okay? Tell the wife that as well.
Neighbor: Yeah. We’re keeping him going. We’re keeping him going. It’s okay.

13:38
Craig: They are coming as quickly as they possibly can.
Neighbor: Yep. That’s fine. What I’ll do is keep an eye out the front window and I will see …

13:46
Craig: Ask her, is the front door open?
Neighbor: Is the front door open? Yes.

13:51
Craig: Okay.
Neighbor: Right. I’ll just run down a second and have a look.
More conversation between bystanders.
Neighbor: I’m just going to step outside and see if they’re on their way.

14:11
Craig: All right. Okay.
Neighbor: I don’t think there’s anything.

14:16
Craig: Okay. Go back up to your grandpa, look, and just keep on encouraging him and telling him to keep going, okay?
Neighbor: Okay.

14:22
Craig: The ambulance crew will come straight into the property.
Neighbor: That’s okay. The front door is wide open and ready.

14:27
Craig: Great.
More conversation between bystanders.
Neighbor: He’s keeping the pace. That’s fine.

14:41
Craig: Great. Okay, they are coming as quickly as they can for him, okay?
Neighbor: Yeah. That’s fine. That’s no problem.

14:57
Craig: Tell him to keep going. We are going to do another 100 compressions now. And then I’m going to give you some more information. Okay?
Neighbor: Okay. No worries. Just another hundred compressions now, Granddad. Then I am going to …

15:10
Craig: I’m counting this side as well for you, okay?
Neighbor: Yeah, he’s doing marvelous, he’s got the pace going just fine.

15:18
Craig: Okay, just to prepare you now for the next stage, okay?
Neighbor: Yeah.
Compressions are now audible.

15:28
Craig: I’d say it sounds like you are doing really well there with the compressions! Tell him to keep going, okay?
Neighbor: Keep going.
Compressions continue.

15:40
Craig: Listen. You all are doing really well there, okay? You are doing brilliant at the moment, okay?
Neighbor: Yup. Yup. Do you want me to take over?
Compressions continue.

16:00
Craig: Okay, listen very carefully. I am going to tell you how to give mouth-to-mouth.
Neighbor: Yeah, okay.

16:06
Craig: Place your hand on his forehead, the other hand under his neck and tilt the head back.
Neighbor: Okay, so I can do this while he’s doing compressions, yeah?

16:12
Craig: Tell him to stop the compressions while you give …
Neighbor: Stop the compressions.

16:15
Craig: All right. Now pinch his nose closed.
Neighbor: Yeah.

16:17
Craig: And completely cover his mouth with your mouth.
Neighbor: Yeah.

16:20
Craig: And blow 2 regular breaths into the lungs about 1 second each.
Neighbor: Okay. Okay, I’m going to pass the phone over, a minute …

16:26
Craig: The chest should rise with each breath.
Neighbor: Okay, bear me a second.
Two breaths heard and conversation.
Neighbor: The ambulance crew just arrived now. I’ll just hand you over …

16:47
Craig: No, I don’t need to speak to them. Okay, I’ll leave you go with them, okay?
Neighbor: Thank you very much for your help.

16:50
Craig: You’re welcome. Take care. Bye bye.
Neighbor: Bye.

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