Lois Rogers

http://www.dailymail.co.uk/health/article-4913018/999-call-handlers-asking-public-perform-CPR-deceased.html

Emergency call handlers are routinely issuing ‘grotesque’ instructions ordering callers to attempt to resuscitate the bodies of loved ones who are obviously beyond help, The Mail on Sunday can reveal. In horrific accounts given to this newspaper, readers have told how they were commanded to perform futile chest compressions on corpses already blackened with decomposition, stiff with rigor mortis or badly damaged.

Some told how operators ‘shouted’ at them, despite protestations that a parent, spouse or other family member had ‘been dead for hours’.

Others were told they would ‘get into trouble’ if they did not comply with instructions, and they spoke of how they were made to feel ‘guilty’ for not doing enough if they objected to carrying out CPR attempts.

But one 999 insider admitted they felt they had no option but to follow the protocols to avoid legal cases against them for ‘lack of duty of care’.

The revelations last night led senior medics to call for an urgent overhaul of emergency call rules, saying they ‘lacked common sense’ and were inhumane.

The issue was highlighted in May when our resident GP, Dr Ellie Cannon, mentioned in her monthly column one such incident she had been told of. She was inundated with emails and letters revealing similarly traumatic stories.

One typical experience was recounted by Susan Laverick, 59, from Ramsgate, Kent, who wrote: ‘I went in to give Mum her pills with her morning cup of tea and found her lying face down on the floor. She was cold to the touch and it was obvious that she had passed away.

‘She lived with us, but I hadn’t heard anything. I think she must have died during the previous night.’

Her mother Doris was 83. She had worsening dementia, diabetes and a heart condition when she died in November 2015. Susan said: ‘I immediately phoned 999 and after asking me if Mum felt warm – she wasn’t – the operator insisted I turn her over. Mum was quite a large lady, so this was a struggle to do. It also gave me a shock seeing her face as she had obviously broken her nose in the fall and her face was covered in blood.

‘I told the operator that her chest was still slightly warm and I said obviously it would be, as she had been lying on it.

‘But I was instructed to start chest compressions. I said her body was cold and it was obvious she had died but the operator started counting and told me to count with her and that I had to do the compressions at the same time.

‘The noise coming out of Mum’s chest was horrendous – horrible gasps. I stopped. I just thought I shouldn’t be doing this to my mother. I kept saying “She’s gone, I know she’s gone”, but the operator was really insistent.

‘She just kept saying, “You are pumping her chest, aren’t you? You must keep doing it to help her.” I just pretended I was carrying on.

‘The ambulance men arrived within three or four minutes. I passed the phone to them and they took over, but after a couple of minutes they said there was no point.

‘I just sat on the floor and sobbed. Afterwards when I thought about what had been done, I realised how shocking the whole thing was. A post mortem showed she had died instantly of a massive heart attack and wouldn’t have known anything, but it has stayed with me. It was not what should have happened.’

Susan is not alone in dealing with a system that appears to ignore common sense.

Other readers said they were threatened and told they would ‘be in trouble’ if they did not comply with instructions to perform CPR. Many have been left with painful memories of hauling corpses into different positions.

One reader, who asked not to be identified, spoke of her ordeal when her husband died. The 83-year- old from Guildford, Surrey, said: ‘He had passed away peacefully in his chair. But I was ordered to get him on to the floor and told to do CPR.

‘It has left us with quite dreadful memories of his last moments – the pounding of a lifeless body.’

Another, named Janet, had a gruesome experience on finding an elderly neighbour’s body. ‘As soon as I stepped into her flat I knew she had passed away. I phoned 999 but didn’t know which service to ask for.

‘I told the operator my neighbour had been dead a while – she had turned black – and the operator asked more than once if I would be prepared to do CPR.

‘I begged her not to make me do it, and waited outside until the emergency services arrived.’

A 999 call handler who contacted The Mail on Sunday anonymously explained that they had no choice but to give these instructions, saying: ‘We can be sued if protocol is not followed. Some health trusts may insist that operators persist with CPR instructions to avoid any claims of lack of duty of care.’

But Dr Gordon Cauldwell, a consultant physician from Worthing, West Sussex, said: ‘What is happening now is quite grotesque and should be stopped.’

Cardiopulmonary resuscitation, or CPR, can be life-saving if given within minutes of a heart stopping, keeping someone alive until the emergency medical services arrive. The most important elements are chest compressions to mechanically pump blood around the body and rescue breaths – the ‘kiss of life’ – to provide oxygen.

Dr Cauldwell said: ‘In ordinary dying, particularly in old age, or after long illness, all the vital organs fail and the heart is the last vital organ to stop. In those circumstances [CPR] cannot restore life.’

Emergency call handlers will advise a caller to start CPR if they discover a person who is not breathing, and has no pulse.

Training instructions for 999 operators, which are produced by NHS Pathways, also give four ‘common signs’ of irreversible death – where CPR will not help: rigor mortis, obvious swelling or decomposition in a body dead for some time, or bodily damage, including decapitation. But the documents, which were obtained by The Mail on Sunday after a Freedom of Information request, advise handlers not to ask people to confirm signs of death, such as the pooling of non-circulating blood under the body, which causes skin to discolour.

The guidance for 999 call handlers advises: ‘… [give] resuscitation advice to anyone where death is not expected, no terminal illness is identified… and there is not a discovery of a corpse or stone-cold body.’

However, a ‘stone-cold body’ is defined in the guidelines only as one where there is evidence of death from drowning or violence.

The assumption, therefore, is that everyone else should be given CPR – although elsewhere the documents warn that chances of survival after the heart has stopped decline by ten per cent for each minute CPR is delayed, meaning that death is certain after ten minutes.

Rowan Harwood, Professor of Geriatrics and End of Life Care at Nottingham University, said: ‘We seem to have lost all sense of proportion and almost all common sense. You can’t blame the call handlers for doing what they’re told but I think there’s a very good case for saying these procedures need to be re-examined and revised.

‘The chance of CPR working in a frail elderly person who has collapsed at home is virtually zero.’

And Ken Spearpoint, an emeritus specialist consultant resuscitation nurse at Imperial College London, said: ‘We need to discuss a more commonsense, decent and humane way of dealing with this.’

However, a spokesman for the Association of Ambulance Chief Executives (AACE) said: ‘In almost all cases, advice to start bystander basic life support/CPR is appropriate and may give a person who appears to be lifeless a chance of survival, until an ambulance arrives… as recommended by the Resuscitation Council which publishes guidance on effective CPR.

‘The action of dialling 999 is a request for emergency assistance to preserve life.

‘If a member of the public is seeking help to report that someone has died, then the appropriate route of contact would be calling NHS 111.’

A Resuscitation Council spokesman said: ‘The best chance of survival after cardiac arrest is when CPR is started as soon as possible – and it will be of no benefit and an undignified intrusion for those whose death was expected and irreversible.

‘Members of the public may not be able to distinguish between sudden cardiac arrest and irreversible death.

‘The actions of 999 call handlers [are] outside the role and responsibility of the Resuscitation Council, and NHS Pathways develop the scripts used by 999 and 111 call handlers.’

NHS Digital, which is responsible for NHS Pathways, the best-practice guidelines for emergency services, said: ‘Our content supports six of the 11 ambulance services in England and currently reflects the national guidance on resuscitation advice.’

Last night, veteran MP Sir Peter Bottomley demanded that Health Secretary Jeremy Hunt conduct an urgent review of training for 999 operators.

He said: ‘What is happening is wrong. Elderly people should be allowed a natural death.’