Low blood sugar

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Scene 1 · Opening

21.30, the office floor nearly empty. She is still at her desk, the screen lighting her face.

She is shaking, her shirt is soaked through, and when you speak to her the answers do not fit.

Scene 2 · Taken ill

Sweating, pale, shaking. She is conscious and her eyes follow you, but she is hunting for words.

You do not know what is wrong with her, and it is not your job to know.

What do you start with?

• Right move : I leave her at rest in the position she feels best in, I loosen her collar, and I ask how long it has been going on and whether it has happened before.
  At rest, then you gather the facts : The guidance asks you to put the casualty at rest in the position she feels best in, to loosen clothing if it is uncomfortable, to reassure her by talking to her regularly, then to find out from her or from those around her how long this has been going on and whether it has happened before. Those answers are what you will pass on.
• Mistake : I get her up and walk her to the window, some air will sort her out.
  She slides off her chair in the corridor : The first thing the guidance asks for is rest: lying down comfortably, sitting up if breathing is hard, or otherwise in the position she feels best in. Being taken ill can turn into a life-threatening state at any moment: on her feet, a fall gets added to the rest.
• Not the best choice : I go down for a strong coffee from the machine in the foyer.
  The machine wants a badge, and your badge is on the desk : Two floors gone for a paper cup. What she needs is three metres from her chair, and it is not coffee.

Scene 3 · The sugar

She tells you two things: that it has happened to her before, and that she would like some sugar.

There is some on the next desk block, three metres away. She is sitting up, she is talking, she is holding her head.

She is conscious and she is asking for sugar. What do you do?

• Right move : I bring her the sugar lumps and let her take them herself.
  Because she asked, and from her own hand : The guidance is precise about the two conditions: at her request, or at the request of the emergency service you have called, give her sugar lumps. And the civil safety recommendations add the second condition: help the casualty bring her blood sugar back up, if she is conscious. Conscious, able to swallow, and asking.
• Mistake : I give her nothing: I do not know what is wrong with her, I will wait for the crew.
  Here you were allowed to, and told to : The civil safety recommendations say the rescuer's job is to help the casualty bring her blood sugar back up, if she is conscious. She is conscious and she is asking: this is exactly the case they had in mind. The caution that matters applies to unconsciousness, not to the woman holding her hand out.
• Mistake : I go through her bag to find her usual treatment and give it to her.
  Nothing comes out of her bag unless she asks for it : The guidance hedges this action with a condition that is not decorative: at her request, or at the request of the emergency service you have called. A bystander never picks what somebody takes. What a bystander does is hand it over when she asks for it, and tell the doctor on the line about it.

Scene 4 · The call

The dispatcher : “Samu, go ahead.”

Some colour has come back. What do you do with the phone?

• Right move : I ask for medical advice and pass on everything she told me. If he wants to talk to her, I hand her the phone.
  Medical advice, in every case : Ask for medical advice and pass on what you have gathered, then follow the instructions you are given. The guidance even notes that the doctor on the line often asks to speak to the casualty directly. Your job is to report what she told you, not to reach a conclusion in her place.
• Mistake : I hang up: she is better, there is no point tying somebody up now.
  Medical advice is not conditional : The rescuer's job includes asking for medical advice, in every case: it is written with no exception. Getting better after sugar is one more piece of information for the doctor, not a reason to deny him the call.
• Mistake : I put the phone on the desk for her and go and sit down: she is the one who knows, not me.
  She has been hunting for words for ten minutes : It is the bystander who gathers the information and passes it on: how long it has been going on, past episodes like this one, her current state of health. The doctor can talk to her afterwards, but he talks to you first. Putting the phone down and walking off removes the only person who can describe what happened.

Scene 5 · She goes out

The dispatcher was still on the line when her head went back.

She no longer responds, not to your voice, not to your hand. Her chest is still rising.

There are sugar lumps left in your hand. What do you do with them?

• Right move : Nothing. Nothing more in her mouth. I roll her onto her side and I tell the dispatcher.
  Unconscious: breathing comes before everything else : The civil safety recommendations set the two branches side by side: keep the breathing going and the airway clear if the casualty has lost consciousness, and help bring the blood sugar back up if she is conscious. She has just moved from one branch to the other: sugar is no longer an action, it is a foreign body.
• Mistake : I slip the sugar between her teeth: that is exactly what she is short of.
  This is the trap of the whole situation, and it has just closed : An unconscious person does not swallow. What you put in her mouth stays in her mouth, then goes down where the air goes. The guidance gives sugar only if the casualty is conscious; the moment she has lost consciousness, the only job is keeping her breathing and her airway clear.
• Mistake : I dissolve it in a glass of water, liquid will go down better than a lump.
  Liquid goes into the lungs even faster : The problem is not the form of what you give, it is that an unconscious person does not swallow. Sugar, sugared water, it all goes to the same place. The rule cannot be got round: you make nobody swallow who is not responding, you protect their breathing.

Scene 6 · The wait

She is on her side, she is breathing, the dispatcher says the crew is on its way up.

You have four minutes of doing nothing left, and that is the hardest part.

What do you do with those four minutes?

• Right move : I watch her breathing, I cover her, and I do not take my eyes off her.
  Watch, protect, wait : The guidance asks you to protect the casualty against heat, cold or the weather, and to watch her constantly. If things get worse, you call back and say so. Staying is an action, even when it looks like nothing.
• Mistake : I shake her every thirty seconds to see whether she is coming round.
  All you are doing is moving her : What you watch in an unconscious person who is breathing is the breathing, and that is all. Shaking her does not bring her back and risks undoing the position that is keeping her airway clear. If things get worse, you call back and say so.
• Mistake : I put her back in her chair, she will be better sitting than on the floor.
  Sitting up, she cannot hold her head : An unconscious person who is breathing stays on her side: that position is what keeps her airway clear. The comfortable position chosen by the casualty applies to a casualty who is conscious. Since she stopped responding, it is a different instruction.

Scene 7 · The crew

Two people come out of the lift with a bag and a case. You give them what you have: the time, the sweating, the sugar she took, the moment she went.

They take over on the floor, without lifting her. You tidy away the three sugar lumps left on the desk.

You gave sugar to somebody who asked for it, and you did not give her any once she could no longer take it. Those are two different actions, and you did both.