Today’s correspondent ask me to comment on an article which they suggest ‘… implies wrong-doing for someone not qualified, to assist in a resuscitation.’ The article is by Baz Ruddick, ‘Investigation underway into why ‘wardie’ assisted in resuscitation at Ipswich Hospital’ ABC News (Online) 20 October 2020. The gist of the story was that a wards person performed CPR during an in-hospital cardiac arrest when there was no evidence of any shortage of medical staff. The relevant CEO is quoted as saying:
“When we do have incidents like this in the emergency department, everyone has a part to play and that includes our operational staff or what might be called a ‘wardie’,” she said.
“But at no stage would we support them working outside their scope of practice. That is never accepted.”
She said “bystander CPR” training was offered to all staff, but it was unclear whether this particular staff member was trained.
I don’t read the article as implying wrong-doing for someone not qualified, to assist in a resuscitation’ per se (ie any resuscitation) but there was an issue with this resuscitation. It might be expected that if a patient is in a hospital, in the emergency department, they would get advanced life support from medical and nursing staff. One does not expect the sort of resuscitation that one might get from a bystander in the street. There is therefore the institutional question of why a member of the non-medical staff was asked to perform this task when there is no reason to think there were not sufficient people on hand, whose job it was to resuscitate to the patient, to do it?
There is also the WHS issue. Why is a person being asked to perform a task that is outside his or her role? The CEO does note that they train staff in CPR so that they can perform that task and one can imagine a ward person would have to do that if taking a person from the ward to x-ray and the person arrested in the corridor, but she was not sure whether he had that training. And this patient was not in the corridor, they were in the ED.
The issue is therefore that it says there was something amiss in their service delivery and in their management of staff. I do not think it says there is ‘wrong-doing’ if someone who was not qualified attempted CPR in a different context (eg on the street) or even if the trained ward staff participated in CPR if they had the training and there was inadequate medical staff where the patient was. What she does say is she does not expect the staff to do things they are not trained to do; and from an employer’s perspective that is quite reasonable. They couldn’t be critical of a cleaner or ward person for not attempting CPR if they have not be trained to do so particularly when training is available. That is a reasonable industrial response but it does not mean that a person not trained cannot or should not attempt resuscitation on the street if they are the only person there.
I think the issue, as I read the story, is the CEO saying she doesn’t know why he did it given at the time of the interview there was no suggestion of a shortage of appropriate clinical staff and she did not know if the staff member had even received basic CPR training. Patient’s expect to get treated by clinical staff, and hospital’s don’t expect their non-clinical staff to provide clinical care in what should be a reasonably routine event in an emergency department. I don’t see the article as saying any more than that.
There are so many articles in the media about this one. Seems really complex and I guess there will be a final announcement which should settle everyone. I just had a fews thoughts about it , we are indeed very fortunate in Australia with the resources including staff available and I guess by the letter or the law/regulations/ WHS etc if indeed a “wardie” did CPR in a fully staffed facility then its outside the norm here in Australia and other well resourced societies. But what is the norm, in the almost twenty years of my prehospital and inhospital work as a paramedic in a varied number of countries I can say the often the bystander or non trained staff member or just another human being quickly became a huge asset to my practice where resources were limited. Is it possible that everyone engaged as an employee of a health facility is atleast trained to do CPR? Ironically we never know what the other person’s experience and training is compared to what they are engaged as in employment at the time of an “incident”. Very frequently I come across people with huge amounts of experience and training now working well below their skill set for varied reasons…..this very true amongst our health sector often because of where they were trained or language they speak, nonetheless sometimes its best to think of a glass being half full. I don’t comment directly on this “incident “ as there are so many details but its sounds like someone whether instructed or not jumped in to push some chest and we all know getting that cardiovascular pressure up as soon as possible saves lives?
I guess it could be seen as a good heart trying to help get another heart started.
Hope it all works for those involved on this one.
Some interesting history below and how it turned out here where sadly the focus in later years was more about ideology and perception as opposed to an untrained staff member not only being given an opportunity by a maverick but also to be part of one of the most significant events of human history.