To ask anyone with medical/paramedic related knowledge what happened with my mum?

[Quietplaces]

I know the below will sound strange and I'm not asking strangers to somehow become psychic and give me hard facts but this is something playing on my mind so just some 'educated guesswork' would be hugely appreciated tbh.

My mum died nearly a year ago now and the whole circumstances on the day she died have been playing on my mind on and off since but are nagging at me more and more rather than less as time goes on, especially coming up to the first Christmas without her and first anniversary etc.

I don't know how much detail to give but basically my mum collapsed very suddenly at home, later the coroner stated it was a heart attack but obviously we didn't know that at the time. Dad phoned 999 and an ambulance came, then I was only a few minutes after because I was luckily in the area, then not too long after that air ambulance medics came, and then some more paramedics (I think in an ambulance service car but not sure about this bit). They were all working on her for a long time and ended up talking to us for quite a while too during this, asking about her past health etc, which hadn't been at all good, and ended up basically saying they could 'push on' to bring her round (she had barely got heart rhythm I think and hadn't regained consciousness), asking us what we thought, kind of asking us to make the decision, we agreed it wouldn't be worth the trauma to her body so were basically going to take her to hospital to die there.

With everything that went on I feel like I was barely in the room and feel a bit 'dissociated' from that day which for some reason I'm getting hung up on, like I need to be able to process what happened to move on. The air ambulance gave a number to phone them for a sort of debrief and I wanted to but Dad kept saying he wanted to 'soon' and soon never came, now I feel it's way too late to ask them for this.

As I said at the top, I'm not expecting anyone to be able to answer accurately but just any ideas for the questions going round my head might help;

1. I feel I might have been too pessimistic about her previous poor health (I didn't say anything untrue or exaggerate but everything can be put in a good way or a bad way can't it?) and agreed too readily that it would be too traumatic on her to work too hard to bring her round. It felt like the paramedics were asking us to decide whether to keep trying or let her go and since then I've felt like I made the choice to let her die (Dad was understandably clueless). Would the paramedics actually have been led by us if they were on the fence about her chances or were they just trying to involve us and would have made the same choices regardless?

2. Why would an air ambulance have been sent? It felt really strange that they were there, my parents live in a normal town, no access problems or rural setting at all, and it wasn't an unusual emergency, would it have been to potentially get mum to hospital faster or just because they were around?

3. What would be the best way to find out if there were any notes/documents about what happened after this long? I know if it happened in hospital there'd be medical notes but Mum only went to hospital to be declared dead, is there an ambulance version of medical notes I could ask for? I don't think anyone did anything wrong to be clear, I just want to get my head round that day instead of having a weird foggy feeling!

4. Is it too late to phone air ambulance number for a debrief? How long after a death is too long to ask about it?

Paramedics would have tried their best to save her unless she had a DNR. However depending on her previous health/age it could have been too traumatic for her body in terms of recovery and lead to long lasting damage and life limiting issues for the remainder of her time. If she was not breathing, you only have a very short amount of time before the brain becomes starved of oxygen leading to further complications. Recovery isn’t always straightforward in elderly patients. It’s normal to question your decision in this situation and to feel guilt and grief.

Air ambulance is normally sent as they are often able to reach a place quicker than a car/ambulance especially with patients who are critical. Depending on the medical findings, a local hospital may not be suitable for the patient so they may need to be sent to one further away which is much quicker by air. If the patient is able to be taken by ambulance after then they have this option with the ground team too.

Yes the ambulance will have made notes and this would have been stored in her medical file. I don’t know at this point what information they can share but it’s worth trying. Records have to be kept for a certain time period.

hope your ok

I'm not a paramedic, but I definitely think it's not too late to phone. Given everything on your mind, I think you should really consider getting in touch for the debrief.

Sorry about your mam, OP, and it's especially hard to lose someone suddenly and near Christmas. The first year anniversary and first Christmas are huge milestones; hope you're looking after yourself xx

I'm sure you can still ask for a debrief and can request any details they hold
Air ambulance would usually be just to get there quicker, it would have been what they had available suitable for the job

With regards to what happened, it may have been they were trying to lead a bit into it wasn't looking good and talking about it preparing you and making the decision with you. Also how long someone has been without oxygen can have a massive impact on their brain. If they thought 100% she could be successfully resuscitated with no lasting effects, they wouldn't have even asked or talked about it
I would imagine they've thought more complications with previous history, been too long perhaps without oxygen and it was prolonging life for perhaps a few days

For me - we made the decision for my mum when she had sepsis to not give any antibiotics. That's because she had Alzheimer's and it was a "better" death if that makes sense, rather than her being stuck in her body for years longer

(Not medical but worked for ambulance service for 11 years)

I think you can still ask for a debrief and should.
When medical people have this kind of conversation with a family, it means that there is no hope for a meaningful recovery, and that they want to agree with the family not to contribute with invasive and ineffective efforts.
There's no doubt in my mind you did the right thing.

Sometimes treatment at the end is a balance between prolonging life or extending the death process. It sounds like it was sudden which might have been kinder for her but sadder for you.

She died at home surrounded by her loving family not in a scary ward.

I think you should give yourself some peace. Take care

Really sorry about your mum. Definitely ask for the debrief. I think the paramedics were being kind and involving you in the decision. If they could have resuscitated your mum they would have. CPR is also very rarely successful, I think we have the idea it’s more effective than it is because of TV shows, it only works about 10% of the time.

Nurse here and have experienced similar.
air ambulance as quite often all that’s transmitted initially by 999 responder is critical patient/cardiac arrest so they arrive not knowing circumstances- may need to transfer to specialist hospital. Doctors also on board to support paramedics.
they would not have been led by your decision, ultimately it is down to them but it’s always better to have family support. Outcome would have likely been the same even if you asked them to keep trying- either she would not have recovered (cpr is unsuccessful in a high percentage of cases, even more likely if older or in poor health) or they would have brought her back and, in my personal experience, have kept her on life support with potential brain damage until life support was withdrawn.
I think air ambulance will still be able to do a debrief, they have to keep notes for quite a few years I think.
im sorry if I sound blunt, it’s the worst thing in the world losing someone so suddenly but what I’m trying to say is that nothing you did/didn’t do would have changed the outcome. It’s awful, but it’s not on you x

If the information is in her medical notes you have 10 years to ask to see them. I considered asking to see my mums several years after she died but decided not to in the end.

I am a Dr but not an emergency one and not a paramedic. I can't speak to the air ambulance but I have had occasion to discuss DNAR with a lot of families although not in the acute situation
Please be reassured that whether or not to continue resus is a medical decision that families neither would nor should not be expected to make. What they were doing was just trying to get information about her health and functioning to inform that decision and gauging your views but not asking you to decide. If you had said she was fine before and you wanted everything done to be honest they would still very probably have stopped as it's a clinical decision influenced by age and by the kind of arrest (eg whether there is a 'shockable rhythm' or its pulse less)
The chances of successful resuscitation after an out of hospital cardiac arrest are only 10% at best and even if they survive people will often have a poor quality of life. The prognosis is worse for people who are older with previous health conditions so sadly it is likely that once she had arrested there was very little chance of recovery even if they had persisted longer.
Please try not to feel bad and do contact them about the debrief. It will not be too late and dad doesn't have to participate if he doesn't want to

Please don’t think you gave up too soon or gave information that led to her death. What you have described is a team of very senior paramedics. They are experienced in the trauma and distress that can be caused when trying to save a life. Making a decision with the family of when to stop is the kindest thing they could have happened.

The procedures set out in these circumstances are extremely tightly controlled

I requested that a relative of mine was not moved into intensive care. The Doctor readily agreed as it can be quite brutal on the body.

You can request further answers for the treatment she received.

I work in the health service and you should completely ask for a debrief. However much later - please do

I cant say exactly what happened - but some people have a survivable - 'shockable' cardiac arrest (VF or ventricular fibrillation) - where their heart goes into a jaggedy rhythm and can be restarted with an electric shock - those people have the highest chance of surviving.

For other people their heart stops altogether - asystole - or seems to work electrically but does not pump - PEA or pulseless electival activity - suggesting the problem is elsewhere in the body eg the brain or lungs - or that something has fundamentally broken. Those people are much less likely to survive.

If paramedics assess they are working on someone who is not going to be brought back - they will try and let family members know this - building up, and trying to get the family to understand that continguing resuscitation attempts will not lead anywhere. The family NEVER make the decision or have the final say - it is a medical one - but getting the family to understand that resuscitation is going to stop is important

So I dont know what happened to your lovely mum - but you did not let her die or not fight hard enough for her. If they thought she could have survived they would have carried on.

I’m a nurse and hopefully I can answer this a bit in a respectful way. I’m an elderly nurse, I’m assuming your mum was older?

first of all it’s definitely not too late to ask for a debrief and cardiac arrests are traumatic, even us who work in healthcare are offered debriefs and we see them more than the public so please be kind to yourself ❤️

The air ambulance was most probably because it would have been the highest category of emergency. In CPR, they would have had the final decision given her history, just like medical staff in hospitals, but asking for your input was probably to gauge how you felt as it’s a lot easier to gain family’s input than outright make a decision that is upsetting for family.

Many people don’t realise that the odds of surviving a cardiac arrest in hospital are low and they are even lower in the community. CPR is brutal and some peoples bodies don’t have the reserves, so go through the trauma of CPR, only for them to have another a few days later and pass away, or they end up brain damaged due to hypoxia (lack of oxygen to the brain during the downtime of the arrest) and needing 24 hour care. I’m be worked shifts on a cardiac unit before and it’s eye opening ☹️

im not sure if the same for all trusts, but in our trust, paramedics records are stored in the patients medical notes with all of their hospital stuff.

It sounds like in the circumstances, your mum was surrounded by those who loved her and it’s clear from your post you acted in her best interests, although it’s understandable that you have some doubts. Look after yourself ❤️

Thank you so much for all the quick replies, sorry not to reply to each comment but all that info has really helped put my mind at ease a bit more. It's a relief to have the 'reality' pointed out and that they wouldn't have been relying on me to make a decision. I appreciate them involving us in the conversation and can see how just telling us what the outcome was would have felt just as bad but definitely feel a weight lifted that it wasn't my decision either. Mum was well into her 70s and didn't have a DNR but had poor health with a few different conditions for quite a few years so it makes sense that they'd have weighed that all up, I hadn't considered the effect of the oxygen deprivation and the CPR tbh as well.

It's already starting to make more sense to me now, obviously the whole thing was horrible to have happened anyway but having it as some weird foggy 'dream sequence' that I couldn't quite understand was even worse. I'll definitely get in touch for a debrief now I know it's not a ridiculously late time to ask but already feel a bit more at ease, thank you all.

I do agree with others that basically if the question 'should we stop?' Is being asked at all then it is more of an attempt to prepare the family for resus to stop than an open question.
If they thought it was reasonably survivable then the question would not even be asked as everyone would just be too busy continuing the resus.
It's very common for families to feel responsible though. I had a good friend who is also a Dr who felt for years that he had been responsible as a teenager for the decision to switch off his mums life support. It was many years later that he realised he could not have been.

I was definitely more focused on the all or nothing of whether they'd brought her back that night or not but thinking about it with all your comments, the recovery afterwards would have been very difficult too. A neighbour had kindly started CPR but there was no guarantee that would have worked well, mum was old and overweight so the odds were lower anyway and thinking about her trying to recover makes me wonder how she'd have managed, any illness/issue seemed harder to recover with than other people let alone something that serious. There had already been discussion about an operation to help her heart (I think something to do with the valves but I'm extremely fuzzy) but they couldn't because her kidneys would probably not have managed so it sounds like recovery would have been extremely difficult. Thinking of it that way I wouldn't want her dead either way but it wasn't a simple 'be fine afterwards' option so at least it was quick and hopefully painless.

Involved with lots of arrests in my work role over the years. Agree less than 10% patients who arrest outside of hospital survive to discharge. Not all of those that survive have a good brain function outcome. The odds of good outcomes decrease with age and as the patient has more health conditions.
As a cardiac arrest is one of the highest priority calls then quite common to dispatch air ambulance as well as ground crew so nothing sinister in that at all. It is likely that the responders were trying to lead you gently to the realisation that their attempts were going to be unsuccessful. I always think the media portrayals of resuscitation attempts do not show how brutal it can be or the low success rates perhaps leading to people feeling that it should be successful and therefore attempts should be continued.
Echo a previous poster she died at home with her loved ones near, your mum would not have known anything about it. My own parent died in very similar circumstances but was home alone so no attempts at resuscitation. I took great comfort in the fact that it was quick with no prolonged deterioration or dependency as would have hated that.

I'm not medically qualified but I can empathise with your questions of whether enough had been done.

Last spring DH and I went on a very much needed and long booked holiday - in the previous 3 weeks we had lost FIL and MIL's DM a week apart. Twelve hours into the holiday (we were nearly 2000 miles away), my DSM called me to say that my dad had sepsis. Decisions had to be made about my dad's treatment (DSM and I had joint power of attorney as he had vascular dementia) and because I was so far away I had to tell my DSM that she and my brother had to make those decisions based on the face to face advice of the doctors and that I would trust their decision. The two choices were to administer antibiotics via suppositories (very undignified and uncomfortable, and couldn't see my dad cooperating with that) or to let nature take its course. They opted for the latter (I reassured my DSM that my gut instinct was that that was the best for him) and he was returned from A&E to his care home (on his return he perked up and said "Oh, I'm home".
He lived another fortnight and I have moments of "what if we had opted for the antibiotics instead?" but realistically I know that he would have hated the antibiotics and fought their administration, and that his general health was poor so forcing him to go through invasive treatment wasn't in his best interests. I still miss him every day though.

I'm so sorry about your mum. Sadly we had a very similar experience with my mum a few years back (barring the air ambulance). My dad and sibling also had to perform CPR on her until the paramedics arrived.

They worked on her for an hour and managed to restart her heart several times but mum never managed to maintain a rhythm. They also used a shed load of adrenaline. They asked my dad and sibling if they wanted them to continue working on her but made it clear the likely outcome was if they managed to stabalise her enough to transport her, she'd die in hospital so my dad gave permission for them to stop. Of course realistically she'd been dead the moment she collapsed. The paramedics led my dad and sibling to their own conclusion - there was nothing more they could do.

I arrived after the paramedics had stopped working on her but I'd have taken exactly the same position as my dad and sibling. She'd had enough, they couldn't revive her and it was better she died at home than go to hospital to die alone (was the height of Covid so we'd have not been allowed to see her)

In all honesty the pain and shock and disbelief of that day never eases. It was life altering.

** My mum wasn't diagnosed ill but had very poor mental health, hadn't seen a HCP for 25 years + and wasn't in good shape overall (didn't eat much, drank told much alcohol, didn’t have HRT for her menopause) but the nature of her death was incredibly traumatic.

Be kind to yourself and seek any answers you think may bring you solace.

ETA - with regards to the air ambulance (as I understand it at least) they are on hand to deal with the most poorly patients but it's usually just the luck of the drawer if the air ambulance can attend - is the craft available? Can it land? Is it going to be able to get patient to where they need to be? (Not all hospitals have helipads and some incidents require specialist hospitals. IE in London liver trauma would be routed to the Royal Free where possible and stabbings are routed to Royal London but the Royal Free doesn't have a helipad so a land ambulance would be required if possible). Its down to logistics and luck as to whether the air ambulance can attend.

When my niece died, the intensive care drs said to us ‘it’s not your decision to make, to continue to keep her alive. It’s ours, but we want to know your thoughts and feelings so we can work together. But it’s never down to you to make that choice’.
it helped so much to know this.

Sorry for your loss.

I'm a Paramedic, but I can't speak to specifics of your mother obviously. I can talk about some related factors with my experiences and some of it may fit in to what you experienced. I second what others have said, you can always email the trust and ask for a bit more information about that day. A patient report form will have been completed that will document very clinically what happened, whether this is ever released to family i'm not sure but if you explain you've had some persisting questions that have bothered you I would certainly expect them to try and help you with answers.

I'll start by saying out of hospital cardiac arrests are very rarely survivable. Only about 4% will ever leave hospital and this tends to be children/the 40-50 yr olds who had a heart attack but otherwise no medical history. Anyone over 65yrs, especially if they're diagnosed with a heart/lung or kidney condition - it's exceptionally rare to survive an out of hospital cardiac arrest. This sounds odd, but you have to be quite 'fit and healthy' to survive a cardiac arrest - I say it sounds odd because you don't normally associate people who are fit and healthy having cardiac arrests - but what can happen in these groups is their heart just has a brief electrical abnormality/small obstruction in blood flow that stops it working - but this is something relatively easy to fix if they survive to hospital and the doctors can make their repairs and recovery is possible.

CPR doesn't 'cure' anything, it's a temporary measure to maintain blood flow to the brain/body so it survives for Doctors to treat the cause. Even when successful at restarting the heart. So in a patient who's got chronic health conditions/frailty which has deteriorated to the point of cardiac arrest even when CPR is successful all of those problems remain, plus now the body has been severely weakened by the event itself.

Ambulance triage/resourcing - when it's recognised in a 999 call that a patient is in cardiac arrest/not breathing they'll try and resource it with 2 ambulances and a specialist whom normally works on a car but there's the helicopter too. The only time they don't is if the caller also says the patient is cold and stiff/report there is a DNACPR in place - the call taker can't ask this but if the caller volunteers this then the patient is considered definitely dead and gets recoded cat3 where someone would be sent ideally within the hour to formally recognise this. Any other time all cardiac arrests are treated by the call takers/dispatchers the same - be it a 13 year old or a 83 year old. If it's busy/location dependent there sometimes just isn't the resources to send but they'll send what they can.

Not everyone in greens on an ambulance is a paramedic. It can be that the first on scene is actually a hospital transfer crew for example so you'll have two people who look like paramedics, have a defibrillator and know how to use it and be trained very well in CPR, but not paramedics.

Initially whomever arrives first establishes that the patient is indeed in cardiac arrest (not just unconscious etc), and that there are no circumstances which point to the patient clearly being deceased i.e. they have rigor mortis because they died some time ago or the arrest was unwitnessed and it's likely no cpr has occurred for 15 minutes and the patient has no electrical activity in their heart. Assuming these conditions are not met then CPR is initiated by whomever arrives.

CPR - initially pads on chest, shock or not shock, chest compressions and starting to breath for the patient. You then work in 2 minute cycles with chest compressions and ventilations before reassessing. If just two people on scene or no paramedics you might not move beyond this type of CPR. When more people/paramedic arrives you try to progress to what's known as advanced life support, the main difference is that some drugs can be administered, but it's the 'basic' bit that's most important.

As a paramedic what you're hoping to find is that the cardiac arrest was witnessed and recognised, good quality bystander CPR was started straight away (any more than 4 minutes delay and even the young 'healthy' patients have a significantly diminished chance of recovering), amazing if a community defibrillator was available and used prior to our arrival, that the patient is in a shockable rhythm - if all this is present you're thinking this is one of the patients you might be able to get to hospital with a heart beat. Otherwise you're working on them to try and get them into a shockable rhythm. Generally speaking, if this hasn't occurred in 30 minutes we stop efforts to resuscitate at this point (it used to be 20minutes but evidence suggested increasing to 30 a year or so ago).

Once resuscitation is ongoing, and there's enough people there to free someone up to speak with the family we'll try to make this happen, that person would explain what we're doing, then establish the events which immediately led upto the cardiac arrest and gather significant medical history for two main reasons - can we establish a likely cause, is there anything that might suggest that efforts will be futile. From this conversation, and events during resuscitation one of several events can occur:

Heart starts beating again - keep the patient still and let them stabilise for 10 minutes before carefully transporting to hospital.

May have met certain criteria to be transported with CPR in progress - there are certain situations where if the heart doesn't restart in the first few rounds of CPR, i,e, 6minutes or so ideally they'll be rapidly transported to hospital with CPR in progress - this doesn't happen that often in my experience.

Decision to continue CPR so that a minimum of 30 minutes CPR has occurred - hoing that in this time disordered electrical activity appears which can be shocked and converted into order and the heart is restarted, but if at 30mins there's no electrical activity in the heart, to stop CPD. This is the normal outcome unfortunately - if the patient hasn't responded in the 30minutes then that's taken to mean that essentially they won't respond and that's the time to stop. This decision typically can't be made for under 18s by most paramedics in most situations - they are more likely to be transported with CPR in progress.

Finally a paramedic is trained to and can make futility decisions. Whether this is to cease resuscitation before 30minutes, or perhaps not even start (i.e. arrive and recognise the patient is clearly in terminal stages of disease so not begin CPR with/without a DNACPR decision previously). This decision must be clinically valid and takes in all the information - everything from how long for CPR to start, what heart rhythms have been seen, what medications did they take/previous surgeries/known to have any organ disease, age/normal activity levels abilities, physical health... The information the family give at this time is only a part of the picture that leads to the decision. Family wishes do weigh on the decision, but they certainly wouldn't result in a paramedic stopping cpr they thought could be successful. For me a big part of this conversation is bringing awareness to the family that resuscitation likely isn't going to be successful, we're likely to be stopping in the house and their loved one will have died, do they want to be in the room in these last moments/hand holding or similar. Recognising that the family/NOK are essentially patients that we will be looking after as well, nothing is going to make this situation ok, but sometimes little things can make a difference.

In the information you gave it may be they were attempting to restart her heart for 30minutes (or 20 before guidelines changed) and she didn't respond unfortunately and the conversation you had didn't actually factor into the decision at all but was just the paramedics process for understanding your level of awareness/thoughts so they can support you as best they can through what they knew was going to happen next. But also it sounds like your mother was a reasonable age, you say she was overweight and had some chronic health conditions, I've no idea the times for starting cpr/crew arrival but this could have all been part of decision making that it wasn't a survivable event, the information you gave would only be a part of this picture and wouldn't have been a strong influence if the clinician felt differently initially.

im sorry for you loss. I'm a nurse and from what it sounds your mum had a cardiac arrest. Statistics show less than 50% survive outside of hospital.
it sounds like they were working very hard to try and save her life. Usually after 15 minutes, the brain can be starved of oxygen and there is also a chance that the ribs are broken during the process. Resuscitation council website has info if you want to look.

seeing a cardiac arrest is traumatic enough and as a nurse I can see and remember vividly the patients I helped but I imagine it would have been a lot more traumatic for you seeing a loved one go through that.

if you can get a debrief please do. I also think you need to access counselling for PTSD/ bereavement if you haven't already. Lots of love to you

I came on to say what @SleepyRich just said so thoroughly. And with regard to the air ambulance, if there was no Critical Care Paramedic available on the ground, they may have been required to sedate your Mum in the event she had a return of spontaneous circulation. Not all paramedics can do this.

Hi OP just my tuppence worth :
Ambulance documentation is uploaded onto our informatics system so if you asked for info/ to rv the case for closure purposes the Trust should hopefully be able to organise this - go through the Trust management system or even PALS even though I know it's not a complaint. It's someone's else's ( your mum's) information is the only problem if that makes sense but it's worth exploring.
The Paramedics / Dr in the air ambulance are in charge of clinical decisions, not you - they were gathering information from you and then checking to see if you would be in agreement with their assessment of what they felt was the right decision. They would take your opinions into account but to support their assessment.
You don't carry on CPR usually more than about 15/20 minutes if the rhythm is non shockable/ asystole - they are several factors to take into account but if there is no shockable rhythm during the resuscitation then outlook is poorer. Unfortunately the chances of recovery from an out of hospital cardiac arrest is low.
Im sorry - what a sad story.

I’ve been a nurse for a long time. I don’t work in acute care now but I did for years. Some of the most difficult situations I experienced were when we had done CPR on a patient (who probably should have had a DNR but the conversation hadn’t been done), they survived but they weren’t conscious, we were keeping them alive with apparatus…then the ICU doctors came to look at them and said they weren’t suitable for ICU. Essentially we were keeping them alive but it was inevitable that they would deteriorate again. It was awful. I remember two patients in particular where I went home and sobbed.
As pp have said, if your Mum had underlying health problems, the chances of successfully performing CPR and getting her back to full health were low. Even in ‘healthy’ adults, quality of life is never as good as prior to the arrrest. It’s not an easy decision to make but it does sound like it was the right one. You make the best decision you possibly could have in a difficult moment.
Ask about the debrief. That information will still be available. I hope that it (and this thread) gives you some comfort 💐

Can I just say from your response you seem like an angel in disguise