- If you have been affected by any of the issues raised in this article you can contact the Samaritans: freephone 116 123 or samaritans.org
As advanced paramedic with the National Ambulance Service, Laura O’Callaghan knew she’d exhausted all she was authorised to do for the man lying in front of her.
His daughter had called the ambulance having found it difficult to wake the mid 70-year-old shortly after lunch.
“He had low heart rate. He was critically unwell,” says O'Callaghan, recalling that afternoon last winter. “We operate under clinical practice guidelines to provide treatments. I gave him medicine and IV fluids so I’d exhausted all measures I’m authorised to do, yet he wasn’t responding.”
O'Callaghan is training to be a critical care paramedic with MICAS (Mobile Intensive Care Ambulance Service) and is attached to CUH as part of the MICAS medical team. She recognised the man needed additional care that she was unable to give.
She also knew moving him posed a problem – not because they were 45 minutes away from CUH in a fairly inaccessible rural location, but because the man’s condition wouldn’t survive being moved. “I knew what I wanted to do for him but it wasn’t in my scope of practice.”
On a team that afternoon with three paramedics, a grade below hers, and aware her colleagues weren’t familiar with what she wanted to do, O'Callaghan did the only thing open to her. She contacted Medico Cork, the HSE’s national 24-hour emergency telemedical support unit, based at CUH emergency department.
“I wanted to pace him – set the defibrillator to a rate that’d ensure delivery of an electrical impulse to maintain sufficiently normal heart rate.”
O'Callaghan had a “clinical conversation” with Medico and got confirmation the course of action she was considering was correct. Once authorised, she carried out the procedure. "It was successful – he was able to wake up and talk to us on the way to CUH, where we brought him to the resuscitation room.”
O'Callaghan found Medico’s support invaluable. “When there’s a lot happening and you’re in the middle of it, it’s easy to initially get skewed in a decision. I got to talk through what I was thinking with someone separate to the situation who understood my reasoning – that was reassuring.”