The call you never want to get in emergency nursing
A newly qualified nurse describes the emotions and impact of a paediatric crash call
The emergency department is an exciting but daunting place to work. A newly qualified nurse describes the emotions and impact of a paediatric crash call
When the red phone rings in the emergency department (ED), your ears immediately prick up as you know a potentially life-threatening emergency is coming in.
It could be anything from sepsis or stroke to a road traffic accident or cardiac arrest. Or it could be a paediatric emergency, the call you never want as a nurse or healthcare professional.
When the doctor or nurse arrives with the pre-alert grasped in their hands, you look at their body language and facial expression to try and gauge the seriousness of the call. As a newly qualified nurse, when this is followed by the words ‘paediatric crash call, five minutes’, your heart rate increases, you feel nervous and nauseous, as you know this is as serious as it gets.
‘You feel nervous and nauseous as you know this is as serious as it gets’
Resus turns into a busy place as the team members converge, nurses and doctors from various specialties arriving in the ED from across the hospital.
Roles are assigned so that everyone has a clear understanding of what to do when the patient arrives. You look around wondering if everyone is feeling the way you are, but everyone looks so calm.
The patient arrives and the ED team takes over
The doors open and the paramedics are performing cardiopulmonary resuscitation (CPR) on the patient. Any hope that return of spontaneous circulation (ROSC) has occurred in the ambulance is dashed.
You brace yourself, ready to take over CPR. You remember your training, shut off your emotions and focus on saving the patient’s life.
Two minutes of compressions feels like forever. Rotation with other team members is imperative as chest compressions are tiring, even more so when emotions are running high.
At the end of each cycle, you look at the monitor in the hope that you have ROSC, but no. The same happens cycle after cycle. You stay focused in the hope that something will change.
‘The hopeful glances at the monitor stop and you start to form an outcome in your head’
When you get the blood gas results, your heart sinks; the pH is awful, the potassium is awful, the lactate is awful. The hopeful glances at the monitor stop and you start to form an outcome in your head. You look at the child, knowing you will soon have to stop the resuscitation attempt.
Staying focused when hope is lost
The family are brought through during CPR. You are aware of them and can hear them encouraging their precious child to keep fighting, telling them how much they love them. This is hard to hear but you don’t internalise it, you stay focused on your job.
When it is time to stop CPR, the consultant explains to the family that the team has done all we can and we now need to stop. You take a step back and look at the child lying peacefully on the bed, but all you can hear are the screams of a family in utter distress.
You feel sick, your heart is racing, and you completely zone out. Although you can hear noise, it feels like you are in a bubble. Inside you are distraught but you hold yourself together, keeping your emotions in check because you don’t want to cry in front of your colleagues.
‘If we don’t feel emotional, we are not in the right job’
Afterwards, everyone involved in the arrest is called into a debrief. The consultant starts by thanking everyone for their efforts, teamwork and compassion, and reiterates that it is normal to feel emotional under the circumstances; if we don’t feel emotional, we are not in the right job.
There is a strange silence as everyone takes a moment to reflect and process what has just happened.
The aftermath of a traumatic event
I eventually leave work but avoid going home straight away as I know the onslaught of emotions is going to hit me as soon as I open my front door.
When I do get home, my daughter is sat on the sofa and my wife is coming down the stairs. I start sobbing uncontrollably and when my wife asks what is wrong, I can’t speak. I eventually get the words ‘paediatric crash call’ out and she hugs me tightly as the tears stream down my face.
The next few days and weeks are a rocky road – I have vivid flashbacks and question if I did everything right. I think of the patient’s family and how they are coping.
Support from fellow team members
Having a supportive team at work makes all the difference; asking if I am okay, giving me a hug or a smile, it all helps brighten my day.
You see the worst and the best of life in the ED and it is important to share experiences. It helps you keep things in perspective, make sense of situations and manage your emotions.
Experiencing one of the worst situations possible with colleagues, some of whom you may not have worked with before, gives you a new bond and a new-found respect for each other.
Then there is my wife and children, who are always there to mop up my tears and give me a hug. Even though they don’t know exactly what I am going through, they are always there to support me and understand that being a nurse can be hard.
As one of our amazing nurses told me, it is okay not to be okay.
Andrew Haydon is a newly qualified staff nurse in an emergency department