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Cardiac Arrest Call The public have been troubled by the latest Do Not Resuscitate stories in the media. Firstly it has to be said that cardiac resuscitation is a very traumatic experience. The chance of survival is low because there are many factors that are involved.
Every resuscitation team should consist of a house officer, Senior house officer, Registrar and anaesthetist. In places like Stoke on Trent, where economics have mattered for decades, there is no registrar or anaesthetist! Only 1 patient in 10 survives resuscitation and this is dependant on what rhythm the heart takes (and if the doctor is able to read the rhythm!) The procedure usually lasts for 15 minutes. DNR, or do not resuscitate orders, are quite commonly placed on notes without consent of the patient. It should be noted by the public that, although this is not illegal in a court of law, it is morally and ethically wrong. It is the patient´s right to know their status and to have their status explained to them. There may be instances where resuscitation would not be successful; end stage carcinoma, for example. Nonetheless, it is imperative to discuss a person's quality of life before such decisions are made. A unanimous decision, not a godlike unilateral decision should be made. In real life, the junior doctor is bullied by nursing staff insistent on a resuscitation status. In a busy day, there are many who may give in due to lack of support. Many consultants live with management meetings and indeed my consultant only came on his ward round once a month. Otherwise he could be contacted on his golf course! They may be at private hospitals as many have this commitment. There are not enough staff and the junior is left stranded, being forced to make a decision on their own. I am sceptical whether B Wilson in the recent case with Mrs. Baker in Portsmouth was directly at fault, given that her seniors would have known of the status on ward rounds that occur every day! It is unfair to scapegoat a junior doctor in this way as there are many factors involved, and many reasons as to why she was forced to make that decision. Even if she had done this, it would have been known to her senior team and nurses who were just as guilty for not saying anything. Furthermore this should have been reviewed regularly, which apparently was not done in this case. A system problem causes doctors to be blamed. To create caring doctors, one must have a system that is fair, with reduced working hours and decreased bullying from management to do extra oncalls without pay. Our system is forcing our doctors to be callous because there is no incentive to work for. Working conditions are poor, living conditions worse (it has been known for oncall rooms to have rats!) and doctors are blackmailed with references to work above and beyond the call of duty. One should always obtain notes of relatives and ask the doctor about the resuscitation status if the patient is ill. Doctors may not have the time or may forget but if asked they will usually advise you. The BMA guidelines are a good starting point for the public. NB It is imperative that the public make the effort to learn Basic Life support. This will save the patient more than anything else. I recently saved my own father just by simple Basic Life Support. Often ambulances are 10 - 20 minutes late and those with Careline will know that often they fail in their task. In the USA more people know this procedure, which takes ten minutes to learn and may save a life. This can be done at your local St Johns Ambulance Centre, evening classes in your area or contact the Resuscitation Council for further information. Resuscitation Council Tel : 0171 388 4678
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