When David Kaufman went into cardiac arrest at his home, high in the Mendips, DSAA were called to assist...

The call to 999

My partner of 40 years, Fiona, and I live on a small holding in the Mendip Hills near Binegar with our two pet dogs, cat, chickens and two horses. While Fiona was tending to the horses, I suddenly felt very ill and dialled 999. I then went down to the stable yard to tell Fiona what I had done and she suggested that I go to bed until the ambulance arrived. This process of events was very fortuitous and played a significant part in saving my life.

Fiona called the emergency services to check I had actually contacted them and they confirmed that an ambulance was on its way. She then followed me up to the bedroom, still with the phone to her ear. The call handler asked her, “Is the patient still breathing?” and that’s when she saw that I wasn’t!

Life-saving CPR

Without listening to the instructions over the phone, Fiona grabbed my legs and hauled me off our Victorian cast iron bed (which is very high off the ground) and started CPR. A while ago, Fiona was a volunteer for the Riding for the Disabled Association and had undergone training in first aid and CPR. It wasn’t long before the ambulance crew arrived and came straight upstairs to the bedroom, as the back door had been left open as instructed by the call handler. They took over from Fiona and continued giving me CPR.

Due to the nature of my incident, Dorset and Somerset Air Ambulance were also tasked. The helicopter landed in one of our fields and a local farmer kindly hauled the five-bar gate off its hinges to help their crew gain access to the house.

Our house is situated almost 1,000ft on top of the Mendips and a storm was brewing outside. There was little cover from the adverse weather conditions and the pilot made the decision that is was not safe to fly at that time. The critical care team on board the aircraft joined the paramedics inside the house and went to work on me; I was subsequently placed in an induced coma.

Transportation by road ambulance

I was taken by road ambulance to the Royal United Hospital in Bath with not only the ambulance service two-man crew, but also the critical care team from the air ambulance. The pilot remained with the aircraft, waiting for the storm to abate. 

During my journey to hospital I went into cardiac arrest again, but the professionalism of those attending to me kept my heart beating until I arrived on the operating table. Once there, a stent was implanted into my heart.

Remaining under sedation, I was transferred to the intensive care unit (ICU) of the hospital. I had the added complication of sepsis but thankfully this was treated. I was extubated from respiratory support after five days but remained in ICU for a further week before being transferred to the cardiac ward to continue my recovery.

Unfortunately, I had a further setback when I suffered a major bleed from my intestines and needed to receive seven units of blood. I also contracted MRSA, so I spent some time in isolation before having a second procedure to insert two further stents into my heart. I was finally discharged from hospital exactly one month following my arrival and I am pleased to say that I am making a good recovery.

There were so many people who helped me in my time of need. Without a doubt, Fiona, the road ambulance crew and air ambulance team saved my life, but I also had the most amazing life-saving treatment in ICU at RUH Bath. That is why I feel duty bound to share my story with others and let people know what a phenomenal health service we have, together with the air ambulance charities that complement it.

view from the crew: Stuart Cox - Specialist Practitioner, Critical Care

We were dispatched by air to David’s incident and as he describes, the weather on that
day was challenging, however within aviation limits. En-route, our team discussed where
he may need to be conveyed to ensure that he received optimal post resuscitation care
in a specialist centre.

At that time, we were aware that his transfer may not be possible by air, given the challenging weather conditions. We proceeded, based on evidence that delivering a critical care team to the patient, enabling advanced interventions and bringing equipment similar to that in an intensive care unit, has a positive association with patients surviving to hospital admission.

En-route we received updates from the ambulance crew and were informed that David was receiving optimal management of his cardiac arrest; an integral part of a patient’s ‘chain of survival’.

The Chain of Survival

The chain of survival is four key, inter-related steps, delivered effectively and in sequence, optimising survival from out-of-hospital cardiac arrest. The first two steps were completed by David’s partner Fiona, who recognised at an early stage that he needed help. She rapidly activated the ambulance service and started CPR. The third step was undertaken by the ambulance crew who provided advanced
life-support and restarted David’s heart by undertaking defibrillation and airway management.

Figure 1: The chain of survival.

On our arrival, it was clear that David was still seriously unstable. To achieve the fourth step in the chain of survival (post resuscitation
care), he required support of his breathing, support of his heart and rest for his brain. Continuous infusions of medicines to support David’s heart were commenced, he was provided with an emergency anaesthetic enabling control of his breathing, further support of his heart and the rest of his brain. He was then safely transferred to the Royal United Hospital in Bath for specialist care to undertake percutaneous coronary intervention (cardiac stents).

While en-route to hospital he received several further critical care interventions, including continuous breathing support using a mobile breathing machine, continuous infusions of sedation, ongoing medicine to help his heart to pump effectively and a mobile blood test to assess and treat deranged blood chemistry.

Support of David’s heart was adjusted by our team using the additional information gained from the monitoring line they placed into his artery and an ultrasound scan of his heart. Through this activity, on arrival at hospital, David’s condition had been optimised, enabling the cardiology and intensive care teams to provide further specialist treatment to open up David’s blood vessels in his heart and allow his heart to recover.

It was a pleasure to meet David and Fiona once again when they visited us at Henstridge recently. Hearing about his complicated but
phenomenal recovery and their plans for the future was truly amazing and inspiring.

Please help to give someone like David their best chance of life, by learning CPR.

NEXT: Alice's Story

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