In the Midst of Life

workers, Red Cross volunteers, care assistants, first aid workers – all are shown how to use the AED machine, and the rule is that an attempt to resuscitate
must
be made unless there is a clear and unequivocal order not to do so. This is the DNAR order (Do Not Attempt Resuscitation) commonly used in hospitals. However, in the wider community such an order is not generally available, even if it has at some time been made. A person may have a living will, but if they collapse at the shops, who is going to know?
    In country areas, where a hospital may be some distance away, lay people are trained and given the equipment to resuscitate, so that they can be immediately available. These people are volunteers, called Community First Responders, and they are linked to the ambulance service. I think Kelly and Beatrice’s mother must havebeen treated by such people at first, because two men arrived within a few minutes of Kelly’s phone call, whereas it took about thirty minutes for an ambulance to get to the house, which is in the countryside.
    Since the turn of the millennium, portable defibrillators have been developed and are being used in the community. They are monitored electronically, and require no training. You simply open the lid and all the instructions are clearly printed: lay the collapsed person flat on their back, expose the chest, attach the pads to the points indicated, and switch on. The machine will pick up the extent to which the heart is fibrillating. At a signal from the machine, everyone around must stand back, and a shot of electricity is directed into the heart, which will stop the heartbeat altogether, thus stopping the fibrillations. This can be repeated several times, and will usually allow the heart to restart a rhythmic beat, at least temporarily, until an ambulance arrives with trained paramedics who can administer more aggressive treatment.
    These defibrillators are now available on the open market, and there is a great deal of interest and excitement about them. Supermarkets, shopping centres, sports arenas all have them. Before many years have passed, health and safety regulators will no doubt require every public place to have one. Our love affair with machinery ensures that, once it is available, it will be used – regardless of whether it is appropriate or not.
    Old age is no protection, because this would be described as age discrimination, which is, of course, illegal. I can envisage an old lady, of eighty-five or more, collapsing in a church service. The churchwarden rushes to get the defibrillator. Should the vicar be the one to say, ‘Wait a minute. We all know this lady. Isn’t this what she has said she wants? She is old and ill and lonely. She has told many of us she wants to join her husband, who died ten years ago. She should be left to die in peace. Put away your machine, and in the presence of Death, let us pray.’
    Pity the vicar who has the guts to say such a thing. It would split the parish down the middle. Half the old ladies would say he is ahero; the other half would call for a public unfrocking. Special meetings of the PCC would be needed; the police, magistrates, the local paper, the bishop – it might even reach the ears of Canterbury or Rome!
    The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) issues guidelines to their members on when
not
to start resuscitation. They are in cases of:
     
Decapitation
Massive head destruction
Massive injuries incompatible with life
Decomposition or putrefaction
Incineration – full thickness burns greater than 95% of body surface
Drowning – known submersion for longer than an hour
Rigor mortis
Livor mortis (post-mortem lividity)
The known existence of a DNAR order.
     
    I suppose it is some small consolation to be told that if I have been decapitated, no one will try to resurrect me!
    The ambulance team has an unenviable job. They do their best, but they get a lot of blame from the general public, which is demoralising. In a situation such as the one just described, with Kelly and Beatrice so clearly upset, it must have been profoundly distressing for them. But, legally, no relative can say what medical treatment should or should not be given to another person.
    Success for the ambulance team is defined as ‘admission to hospital alive’, and they are duty bound to strive for as long as necessary – up to one hour – to achieve this objective. They are empowered to declare ‘life extinct’, but as long as