Paramedic Cardiac Arrest Reflection: Gibbs

Description

I was dispatched as the first resource to a report of a collapsed man in his sixties at home. On arrival his wife was performing chest compressions with telephone guidance from the call handler. I confirmed cardiac arrest, took over compressions, attached the defibrillator, and delivered a shock for a shockable rhythm. A second crew arrived within six minutes, at which point I was the senior clinician on scene and led the resuscitation: allocating roles, managing the airway plan, and keeping the rhythm-check cycle on time. We achieved return of spontaneous circulation after the third shock and conveyed the patient to the nearest heart attack centre with a pre-alert.

Feelings

Before the second crew arrived I felt focused but stretched - there is a particular loneliness in single-clinician resuscitation. Once I was leading a team of four, my main anxiety shifted to whether I was being clear enough. Part of me wanted to stay hands-on with tasks I felt confident in, and I noticed real reluctance to step back and hold the overview. Afterwards I felt proud of the outcome but uneasy that the resuscitation had gone well partly because the team was experienced enough to compensate for my thin instructions.

Evaluation

The clinical mechanics went well: early defibrillation, minimal interruptions to compressions, a timely pre-alert. What went less well was my leadership communication. I gave task instructions but rarely shared the overall picture, and I did not name a specific person for each action - twice, two colleagues moved to do the same task while another was briefly uncovered. The patient's wife was left alone in the kitchen for most of the resuscitation, which I regret; nobody was allocated to her.

Analysis

Reading about team resource management afterwards, I recognised the pattern: under cognitive load, new leaders default to doing rather than directing, and instructions become ambiguous exactly when clarity matters most. Closed-loop communication - naming the person, stating the task, hearing it confirmed - is protective precisely because it does not depend on the leader's spare capacity. The gap in family care was not a knowledge failure; I know relatives should be supported and offered the chance to witness resuscitation. It was a role-allocation failure: because I never named it as a task, it belonged to no one.

Conclusion

I learned that leading an arrest is a distinct skill from performing one, and that the quality of my resuscitation leadership lives in the specificity of my language. I also learned that anything I care about on scene - including the family - has to be explicitly allocated, or the scene's momentum will swallow it.

Action plan

At my next arrest as lead I will physically step back from hands-on tasks once enough clinicians are present, use names in every instruction, and give a ten-second shared summary at each rhythm check. I have added family liaison to my personal scene checklist as a role to allocate as early as airway or drugs. I have booked onto our trust's resuscitation team-leader course and asked a senior colleague to observe and debrief my next team lead.