Supporting Bert

East Neuk First Responders

Gillian: My name is Gillian Duncan and I am co-ordinator of East Neuk first responders. Eh we formed the group 9 years ago, we’re an independent local resuscitation charity and one of the things we do is partnership work with the Scottish Ambulance Service.

Ruby: Hello, my name is Ruby Urlotti and I’m a first responder and I was recruited now probably 5 years ago, could even be a little bit longer. Eh and I volunteer on a weekly basis, as a responder.

Interviewer: Do you Gillian, I know you do debrief your first responders, can you tell me why you think there’s a need for that?

Gillian: Well, we were really keen to check that everybody was ok and also to retain our volunteers, so we didn’t want somebody to be put off by a major traumatic incident and not want to do it again. So right from the beginning we wanted to do some kind of debriefing and chatting but very much on an informal basis.

Interviewer: So what sort of form does your debriefing take?

Gillian: Well normally, immediately after a cardiac arrest if I’m not personally involved with the cardiac arrest, so if I’m not one of the team, the team have to phone me and I’ll speak to both the responders that have been involved just to check that they are ok, what happened and they were happy with everything.
At that stage if I was concerned I would take further action, that’s never happened. And then we follow that up 24 hours later I give them another phone call or pop in and see them have another chat, just check. Cos usually by then they have thought of things that they should’ve maybe done better or. So we are able to put their mind at ease that way. And then we’ll continue that on everyday if need be if we thought, you know we were concerned at all. And we have a plan to further signpost them and let our medical lead on our committee know if there was any problems but touch wood so far you know there’s not been any issues.

Interviewer: That’s because you follow it up.

Gillian: Well hopefully, hopefully yeah. And we have never had anybody left as a result of a traumatic incident. And I hope that the training that we do before they’re involved has a lot to do with that. I think we’re slightly different from other community first responder’s schemes in that right from year one we actively, whilst we’ve no formal training we actively had once a year a training session from a psychologist, or the Samaritans we’ve had as well so along that sort of lines we have had some input every year really haven’t we?

Interviewer: And that was the whole team had the input did they?

Gillian: The whole team, yes, the whole team, yeah.

Interviewer: So have you been at the receiving end of this debriefing then have you?

Ruby: Yes, to be fair I have. What is very good from the first responders especially when it is from your first cardiac arrest, your heightened, your emotions are heightened. It’s quite a long process just because there are other facets to it i.e. the police are informed, so with the police being on board and also the crew everything has to be quite exacting. So you are going through a process and that’s what’s comforting for the first responder. And for myself was that I knew that Gillian being my co-ordinator would be following it on, seeing how you are. Its kind of in many ways eh, gives you downtime after all, if I can put it, the fuss has died down. And you’re still there cos you’re practically about the last one on these occasions especially in rural areas to go. So that’s beneficial. And picking up what was said that also your mind you think you’re rested through the night but you’re still thinking about it. And the following day especially after first cardiac arrest you’re physically as well as emotionally tired. And the experience of I being told that your arms will feel like lead, you kind of just brush off but oh yes your arms feel like lead. So its all these emotional aspects as well as what could I have done differently. How did the cardiac arrest for a better word, go down, because there was family involved? So we go through that. So I felt the benefit and we follow it through with others, I’ve seen it that immediately after once its all calmed down that’s excellent that first briefing. But I think its just as important the day after the 24 hours later cause you’ve actually though about it yourself and the questions, and could you have done something else? Generally, the answer is no you couldn’t.

Interviewer: So you very much used it as a learning experience, pick out the points that you could perhaps, how could you follow that up then Gillian?

Gillian: Well we do it training and I think that’s a really important point. Every cardiac arrest we probably use as a learning point because they are all different. And whilst we do, the way we train for cardiac arrest is very much scenario based, we try to make it as realistic as possible. Ruby will tell you we are usually in toilets and things like that when we’re doing training. Because that all adds to the differences and how you can better deal with it. If you come across a situation that’s very different from a big hall and just doing resuscitation practice in a big hall. So we do try to learn from that and we have picked up on a few things and decided to tailor our training to accommodate for things that have happened in real cardiac arrest.

Ruby: I would add to that is that what we find is especially when we’re training, in a training situation it allows the first responders to go back and think about their role and what was happening around the cardiac arrest. I mean in some ways, the best scenario which sounds crazy is that the person is actually in a cardiac arrest on their own. But the likelihood of that happening, so therefore you always have either a friend, a neighbour, a family member, there’s always someone else there. And its their reaction can add to, or how do we deal with them until the crew comes. Because we’re aware that we have 15 minutes, that’s the best scenario to average 45 minute delay. So you know, you’re dealing your best what’s excellent is that we work in twos but we are aware that there is a family member or someone else there.

Interviewer: So there’s always 2 of you?

Gillian: Well not always

Ruby: Well not physically, but we know that the second one’s coming up behind us.

Gillian: We do more so now cause we’re shorter of responders but we do have people that are out on their own now. A good example I suppose of how we learned from a cardiac arrest was probably early on for me is the police interview actually, after it. Because that can be quite alarming because it’s a wee bit like you’re getting checked out. Have you done things properly? I was aware that some people would find that very intimidating. But if they’re prepared and know that’s what’s going to happen every time because you were there first and the kind of things you are going to be asked. If they know that’s the norm its not an issue. So we put that in place that we always talk about that and that’s what will happen and what they should be, you know the kind of thing the police are looking for. That alleviates the stress of that, you know. So I suppose that quite a good example of how we’ve learned.

Ruby: I mean an average cardiac arrest probably the time we actually are able to move on to another situation is at least an hour.

Gillian: Possibly 2 hours

Interviewer: I didn’t realise the police actually came and interviewed you followingr each cardiac arrest.

Both: Yeah

Gillian: Always, I mean there’s, we have to wait, the police initially come and then the sergeant, so there’s 2 police resources, and if they remotely think its suspicious which can be not at all suspicious but they’ve got to take it that it is, you know prolonged, yeah it’ll be prolonged.

Interviewer: So that can be quite a traumatic experience especially as you say especially in your first response.

Gillian: I think, I don’t know how you felt on your first one Ruby, because by that time we were prepared and you know that’s just what happens. The police will be there.

Ruby: I mean the greatest issue we had was ensuring those that were coming behind us actually knew the location. Which may sound a terrible thing to say but it was because the person who had gone into cardiac arrest through the night was in a location that wasn’t well appointed. It was very difficult to find so you knew that nobody was coming quickly behind you. So you kind of had that in the back of your mind as well. But in some ways that kind of provided some rationale, you thought you just have to get on with it.

Interviewer: I think its really good that you do offer this debriefing but is there any other kind of support Ruby that you would have felt would’ve helped you?

Ruby: I think at the time, no. In fairness, I always remember when it was the first cardiac arrest, cause that’s what always sticks in your mind, its the crew themselves were quite supportive, the local ambulance themselves were aware. And they knew that it was my first time because they know us very well. So they supported us but I think if it was someone more official out with, I can’t see myself relating to them… “Thanks very much but you kind of weren’t there”. So I felt that as though you need someone who was a first responder.

Gillian: I do think that’s a very good point because our management do say that they’re always there. If we’re concerned about anything or we feel that we’ve not coped well with, but I think all of the first responders we have talked to, it would be the last thing they would want and they would really push away from any of that., which is a worry because you would rather they would open up to their peers or whatever. I think that would be healthy for everybody but you don’t really want that external input.

Ruby: I suppose when you’re very early on carrying out any first responding, you feel a little bit challenged because you’re aware you’ve had not much experience, so you do feel like you’re being tested and looked at. When it’s within the local team, there’s a much more comfortable situation, so the idea of a monthly training session is good for us because we’ve all been through it, or we’re all going to go through it. So it’s a very comfortable place to be. It is informal but it works.

Interviewer: I’m going to take you back slightly because you mentioned that its always invariably going involve family or friends and I know your team get training on how to deal with stressed relatives – what sort of things do you offer people for that?

Ruby: What is ideal is that – this part of the training Gillian gives – by introducing psychologists to us and Samaritans. We felt very much that they were the people who have to deal with real life situations and they gave us a whole array of examples, which more than covered what we would ever experience. But this allowed us the freedom to say “what if this “or “yes we have this, but what if..”

Gillian: I think very few of us, the team, had the experience of dealing with people in that kind of way and I think the majority of the population would find it difficult to deal with people talking about death and trauma and I think the psychologists and the Samaritans that we’ve had on a yearly basis have given us coping strategies that are absolutely fantastic. We had no idea bout them and they’re very simple. It’s interesting and the training that we had was really beneficial for the people we deal with but also for the responder, even just to keep them calm en-route to an emergency I think it really has been invaluable.

Ruby: It’s been the whole process of keeping yourself calm and to listen – and that applies to everything that we do anyway because if not there’s not point you getting anxious, because you’re not going to be affective, and then you’re not wanting to react to the person who is understandably quite emotional. You just do not know how that emotion will come out. It can be grief, and can be anger, y’know that’s acceptable because sometimes a cardiac arrest can happen and it can be at the end of long-term illness. So bitterness can be there from a family member as well. I remember my first cardiac and it was in the country and I was unprepared for the.. if I could say the ‘nosey-ness of the bystander. We don’t have many bystanders in the countryside but I was quite shocked. They crew were great, they closed the curtains and I was like, “wow”.

Interviewer: So there was actually people watching the bereaved?

Gillian: Yes, we have had – I mean we’ve had a few public cardiac arrests out in the street and people do treat it like a live TV episode and I find that really disturbing and one was with a boat in the harbour and people were filming it with their mobile phones, and that does really put you under pressure. I mean, you’re carrying out your job and you’re really not thinking about the later stages but afterwards it does put you under pressure because you think “they were watching us all the way through”. It never runs according to plan and I have to say for us as much as the trained crews who have a substantial amount training than we have.

Interviewer: So you’re under scrutiny?

Both: Yes

Ruby: Because anybody who has been involved in a cardiac arrest knows it doesn’t go “a,b,c,d” like the book says. When it happens everyone is different and you’ve got to accommodate them and be as best as you can.

Gillian: I remember when in the doctor’s surgery, a golfer had came in from the golf course and collapsed in the waiting room. The nurse and the doctor came out and they were resuscitating. But they don’t deal with cardiac arrests very often, not nearly as often as we do. They were saying that in their rush to deal with the patient, they forgot that all the other people were sitting there and when they did become aware they were horrified, because the people around them were treating it like a live TV episode

Interviewer: I think there’s two aspects, the other is that people can get very upset.

Gillian: That’s true and because it’s such a shocking situation, people di freeze a bit and they feel like they have to remove themselves from the situation.

Interviewer: Is there anything else that you’d like to talk about?

Gillian: No, I mean from my point of view, as the person who is often doing the instructing and leading – people who have no medial background that become responders – not matter whether they got things 100% right – they’re still giving that person a chance that they otherwise wouldn’t have had. And I think that’s what we emphasise and reemphasise. Whilst they might feel slightly inadequate, the very fact they are there and getting the defib on quick , is giving them a better chance. And they can do no harm. I mean, we’re now doing a lot of training, going out and training the public and hopefully getting people who are out in the street who aren’t fist responders feeling the same as well and I feel we’re getting that message across.

Ruby: Yes, the defib awareness has had quiet an impact on the local community. One Cleary can see by the fundraising that it’s been very easily achieved. The number of defibs we have and the number who attend awareness sessions. There’s no surprise that in the youngest of Gillian’s sessions, the younger ones are more keen, confident and capable t and that’s only going to add to better improving the situation. But it’s also helpful to us as responders, that if the message has been carried over from the very beginning when you’re part of the induction to the defib awareness is that just “do something.

Gillian: I think we’re luck y that now nine years down the road, we have quite a few survivors. And that’s always there to highlight. Of course, yes you don’t get everyone that will survive but we do have a lot of survivors and every year and that wouldn’t happen without us. And I mean, that’s really rewarding and we’re able to tell most of eth responders who will know some of them.

Interviewer: And it’s often the young ones who survive that have a long life ahead of them.

Both: Yes.