Some details of the incidents described in this article have been changed or omitted to protect the anonymity of the patients and other people involved. These changes do not affect the clinical or professional lessons described. 

Before – preparation is knowing more than basic life support 

Looking back, what stays with me is not only the clinical response. It's everything around it that I hadn't thought about until I was actually dealing with an emergency. 

I had trained for medical emergencies. Basic life support was important to me because you never know when a life-threatening emergency might happen in clinic. 

But having experienced two patients having serious adverse reactions, I realised there were things I had never thought to prepare for. 

If an emergency happened in your clinic tomorrow, do you know where the equipment is? 

Does everybody know their role? Who calls 999? Who records times and observations? Who keeps the rest of the clinic functioning? Who meets the ambulance team? 

What happens if bodily fluids contaminate the treatment area? Where are the relevant procedures? What information will emergency clinicians need about any drugs you have administered? 

My purpose isn't to make you anxious. It's to get you thinking about all the things that suddenly matter when an emergency stops being something you've trained for and becomes something happening in front of you. 

During – somebody needs to remember what happened  

In one of the incidents, the patient's initial presentation gave little indication of how serious the situation was about to become. At first, there was little to distinguish what was happening from an ordinary faint. 

Then things changed very quickly. The patient's appearance altered dramatically and it became clear that this incident was something more serious. 

It is easy, sitting here now, to describe that sequence of events. It was considerably harder to observe, respond to and remember it while it was happening. 

The patient's family member watched throughout the emergency. As their loved one suddenly became critically unwell, there was little they could do except watch us. Our movements and facial expressions inevitably became the focus of their attention. 

I thought I appeared controlled, confident and calm. It was only afterwards that I began to wonder what I had looked like through their eyes – and what effect the experience had had on them. 

It raised another question I hadn't previously considered – who looks after the person who came with the patient? 

When the paramedics arrived, I expected them to ask about the local anaesthetic. What I hadn't expected was the level of detail they would need about its administration and the sequence and timing of everything that followed. 

Exact timings matter. But the clinician dealing with the emergency may also be the person least able to stop and record them. 

Who in your team does that? 

After – the emergency does not end when the ambulance leaves 

The ambulance had been there for an hour. Somebody had just had a life-threatening emergency. The team was dealing with the aftermath. And meanwhile another human being had arrived because their diary said, ‘podiatry appointment’. 

Nobody had considered who would contact subsequent patients or manage the rest of the clinic. 

I also discovered that dealing with contamination was governed by procedures I had never needed to use before. Finding the guidance, following the required cleaning process and returning the treatment area to use all took time. 

Afterwards, I had to complete the relevant incident reporting and discuss what had happened in considerable detail. 

After the patient is safe, what about the team? 

A severe adverse reaction can be frightening for everyone involved. The immediate priority is the safety of the patient. But the effects on the people responding to the emergency can continue afterwards. 

I struggle to put into words what it was like to see somebody go from a stable condition to such an extreme one in such a short space of time. 

Both incidents also had lasting effects on colleagues who were involved. For some, returning to the procedure afterwards was difficult. It made me realise that an emergency can have consequences for the clinical team long after the immediate danger has passed. 

Two things can coexist – the patient's emergency, and the trauma it can cause for the people responding to it. 

I still believe training matters. Basic life support gave me the knowledge I needed when something went badly wrong. 

But preparedness is bigger than knowing the clinical response. 

It is knowing who calls for help. Who records what happens. Who talks to the relative. Who cancels the next appointment. Where the relevant procedures are. What happens after the ambulance leaves. And who looks after the people who have just dealt with something none of them will ever forget. 

Before your next clinic, ask yourself: 

• If a patient became seriously unwell now, do we know exactly what we would do?  

• Does everyone in the team know their role?  

• Who would call for help?  

• Who would record what happened and when?  

• Do we have an emergency contact for the patient?  

• Who would support the person who came with the patient?  

• Who would communicate with relatives or carers?  

• Who would manage waiting patients and the rest of the clinic?  

• Do we know what to do if the treatment area becomes contaminated?  

• What information would the ambulance crew need from us?  

• What incident reporting would be required afterwards?  

• What support and debriefing would be available to the people involved?  

• When did our team last rehearse what it would do in an emergency? 

About the author 

Fred Bellamy trained at the University of Brighton. He worked for Sussex Community NHS Foundation Trust for 18 years. Fred also maintained a private practice during his career. He provided services to local social care providers for retirees, young people and those with learning difficulties. 

Before a career in podiatry, Fred worked in marketing and communications.