WHEN you’ve worked as a community pharmacist for over 20 years you are bound to have encountered a range of injuries, from the very minor to the more serious requiring an A&E visit or paramedic attendance. What happened in my branch on October 13, 2016 was unusual in that, had it occurred almost anywhere else in the village, the outcome would have been so different.
It had been a typical busy Thursday morning. My team and I had managed to dispatch the deliveries, dealt with the initial rush and had just dared to download the next batch of EPS scripts. I was at my checking bench which overlooks the shop just behind the shop counter.
A man entered the shop and walked to the counter to sign his prescription; this completed he straightened up, took two steps backwards and fell into the shop’s central shelving unit which acted to break some of his fall before he crashed to the ground.
Two staff members and myself rushed to his aid. He appeared, at first glance, to be having a fit: he was breathing in a very strange manner, making a rasping/snoring noise through his mouth, his eyes wide open. He was unresponsive to any stimulus.
A colleague and I put him into the recovery position. I was at the leg end but I noted his legs were stiff so I was unable to bend them and we had to roll him. He appeared to have hit his head on the bottom shelf as he fell and was now lying in a corner of the store.
We checked that the clothing around his neck was loose. I sent someone to get a fleece to put under his head, and as we gently lifted his head I noticed that their was a little blood on the floor underneath, most likely sustained from his fall.
He was still making this strange breathing sound. He was turning more and more purple and his eyes were still open and staring. A member of my staff was checking his pulse which was faint and then suddenly stopped, as did his breathing. This probably all occurred in the space of less than two minutes
As this was all going on I was also directing people. One staff member was told to ring 999, another was dispatched to the GP practice to fetch assistance. There had been two customers in the store as the drama had started, and one happened to be a local dental nurse. She asked if she should fetch a defibrillator from the dental practise three doors away. “Yes!” I replied.
My colleague and I then started CPR: she was doing the compressions, and I administered mouth to mouth ventilation. I remember I was pleased to see that his chest rose and that air was getting into his lungs. I honesty can’t remember how long we did this for, perhaps 2 minutes, although I remember him taking one gasp after I had given the second round of breaths and then he stopped breathing again.
The defibrillator then arrived with another dental nurse and a dentist. We lifted his top and I asked them to set up the defibrillator as they had been trained to use it. Once charged the machine delivered a shock almost immediately and then issued instructions on continuing the CPR.
At this point (about 5 minutes after the start of the incident) a doctor and a member of the surgery team arrived. They had oxygen with them. The doctor commented that he had just seen the patient in surgery and had done an ECG which was normal.
A district nurse also arrived to pick up some dressings. She took over the chest compressions.
The doctor administered the oxygen which for some reason kept popping the tube off the cylinder (we have since found out there was a fault with the mask connection). I held the tube to the cylinder to prevent this.
I think I must have asked a member of the dental staff if they had another cylinder as they returned with a replacement. Once we had changed it we had no further issues and I was able to check on my staff. A colleague was still updating the emergency services operator, the others were preventing customers from entering the store.
The first paramedic arrived after 20 Minutes and two more ambulances came a few minutes later. The four paramedics then took over. The patient’s upper clothing was cut off and he was moved into middle of the shop which offered the paramedics more space to work. The patient remained there for a good while but the chest compressions were stopped as he now had an output.
He was finally moved into the ambulance after some 45 minutes — after a further 10 minutes they departed. On talking to the paramedics they believed the patient had a massive intracranial bleed (stroke) as the way his hands and arms were moving suggest this.
We then started to clear up. The shop was full of feathers as the patient’s quilted coat had been cut by the paramedics and thousands of feathers were released; at one point it was like it was snowing! There were small patches of blood which also had to be dealt with. Customers were served from the door for about 15 minutes until the shop was operational again. Working on for the rest of the day was difficult and only essential work was completed.
There was no news for days. Then exactly one week to the hour after ‘The event’ the man walked in with his wife. He was pale, he was on some new medications, he had a few broken ribs but he was otherwise fine. It was an emotional reunion.
The whole event highlighted the great working relationship between different health professionals, the need for defibrillators in every community and the need for everyone to keep up to date with basic first aid training. It is a day that everyone involved will never forget and a reminder that pharmacies are an important part of the communities they serve, not just the pill counters that some in authority seem to believe.