Alison Roberts - A Nurse's Search and Rescue

They went out the way they had come in, found a gap between the hulks of wrecked cars and discovered a double garage with its side door hanging open.

Two teenage girls, devotees of Gothic styling, sat on a bare mattress just inside the door. They stared at the newcomers with matching blank faces.

‘Hi, there. I’m Matt from the ambulance. This is Joe and Tori. Did you guys call for us?’

‘Yeah.’ One of the girls pointed to the other side of the garage. ‘It’s Charlene. She won’t wake up.’

Another young girl lay on her side between two mattresses piled with some old blankets and pillows that were losing their stuffing. Matt rolled her over onto her back.

‘Charlene, can you hear me? Open your eyes, love.’

There was no response. Even in the dim light provided by the single bare bulb dangling in the centre of the garage Tori could see the blue tinge of cyanosis on the girl’s lips.

Joe was uncurling the leads from the life pack to attach electrodes. He cut through a thin sweatshirt to expose what looked like the underdeveloped chest of a child. Having determined that Charlene was not breathing, Matt flipped open the kit and pulled out the bag mask. Tori grabbed the end of the tubing and pushed it onto the oxygen cylinder’s connection. She fitted the key to the valve, twisted it open and turned the flow up to fifteen litres a minute—the highest available.

Matt tipped the girl’s head back and lifted her chin to open her airway, having checked that there was no obstruction in her mouth. He fitted the mask and inflated the bag twice to deliver two full breaths. Then his fingers went to the side of Charlene’s neck.

‘No pulse,’ he reported grimly.

Joe simply nodded. The display on the screen of the life pack was just settling into a readable rhythm.

‘Fine VF,’ he announced, equally grim. Tori could understand why. When first in cardiac arrest, a rhythm of ventricular fibrillation was coarse, with the wiggles much further away from a flat base line. There was far more chance of converting a coarse VF into a perfusing rhythm. The longer the ‘downtime’, the finer the wiggles…and the less hope there was that a life could be saved.

‘What’s happened here?’ Matt directed the question to the girls still sitting near the door. ‘How long has she been like this?’

One of the girls shrugged. ‘Dunno.’

‘Stand clear,’ Joe directed. ‘Shocking at 200 joules.’

Matt moved backwards so that he wasn’t touching the patient. He put the bag mask down and reached for his radio. After a rapid request for back-up to a cardiac arrest, he turned to his kit.

‘Could you hold the torch to give me some decent light, please, Tori? I’ll intubate in a minute.’

‘Sure.’ Tori clutched the torch and held it high enough to cast a useful circle of light. She watched in dismay as Joe delivered a second and then a third shock, with no change to the fatal cardiac rhythm displayed on the life pack screen.

Matt unrolled the intubation kit. ‘Put the torch down for a sec and hyperventilate her for me, Tori.’

She did as requested, giving the girl as much oxygen as possible before the procedure of securing her airway with the tough, plastic tube. Then she held the torch again, holding her own breath in sympathy with the look of intense focus on Matt’s face as he lifted the tongue with the laryngoscope and angled the light on the instrument to visualise the vocal cords.

Tori was ready with the bag mask when Matt had inflated the balloon on the ET tube to help secure its position. He listened for the sound of moving air as Tori squeezed the bag, to ensure it was going into the lungs and not the stomach which would indicate incorrect placement of the tube.

‘We’re in,’ he announced. ‘Start CPR, Joe, and I’ll get IV access.’

Tori inflated the girl’s lungs twice after every fifteen of Joe’s chest compressions. They kept it up for a full minute, by which time Matt had an IV cannula inserted and a bag of saline attached. Then Tori sat back to allow Joe to start the next series of three shocks. Matt was drawing adrenaline into a syringe. He looked up as he twisted the top off the second ampoule.

‘Somebody needs to tell us what’s been going on here,’ he told their silent audience. ‘It could make a difference to whether we can help Charlene or not.’

His words had an effect. One of the girls burst into tears and the other one put her arms around her.

‘Leave her alone,’ she shouted at Matt. ‘It’s not Jamie’s fault.’

Tori felt, rather than heard, Matt sigh. ‘How old is Charlene?’ he asked.

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