The Crash Team

When somebody dies on a hospital ward, a “crash call” gets put out by a member of the ward staff. This comes through to the pagers of the members of the “crash team” who have only a couple of minutes or so to get to the ward and attempt to literally bring the dead person back to life again.

There is a definite order in which the various members of the crash team arrive at a cardiac arrest.

First there are the nurses due to the fact that they are actually on the ward when the person died and are often the people who put the crash call out in the first place. There’s usually two or three nurses there performing Basic Life Support (CPR) before the crash team arrives.

The first member of the crash team to get there is the Medical SHO. The Medical SHO is usually younger, quicker and keener than the other members and will try her best to organise a working airway, IV access, a heart monitor and give some emergency drugs.

The Medical SHO is quickly followed by the Medical FY1, who is even younger and fitter that the SHO, and would have been there first apart from the fact that he doesn’t want to get there, get scared by the situation and freeze with everyone looking at him and asking “What shall we do now, doctor?”

It takes about a minute or so for Advanced Life Support to get properly underway, and this is the moment when the Medical Registrar pitches up. The Medical Registrar is the leader of the crash team and she’ll have seen literally hundreds of these in her time. She’s got the knack of arriving early enough to potentially make a difference to the patient but late enough to allow the initial panic to die down and for everyone to slot into their roles so she can take over the overall running of the crash call.

Last to turn up is the anaesthetist. It seems that the anaesthetist’s role at a cardiac arrest is to turn up, sneer, suggest to the Medical Registrar that we should all stop now and then saunter off again. I used to think that this was because anaesthetists were lazy, but now I know that the reason we turn up last is because most of the time, cardiac arrests happen on general medical wards and in most hospitals, the general medical wards are nowhere near the operating theatres, which is where the anaesthetists hang out. The other reason is that the medics are perfectly capable of running the arrest without us, so we don’t bother making the long sprint from theatres to the medical ward (up to half a mile in some hospitals) and settle for a slow jog instead.