bright and light

The shift started off great - those of you who follow my twitter feed (@flobach) will have seen why: First job of the night, and my septuagenarian patient gives me a big toothless smile while stating firmly she wants me to be the father of her children.

Sorry, but I have to decline...if you can't look me directly in the eye, I'm not interested. Probably didn't help that I was trying to shine a light right through to the back of your retina, but hey, that's the deal. If you want to marry the doctor, you gotta follow the doctors orders.

Doctor? Yes, my potential wife's carer referred to me as the doctor. Initially I was going to correct her, but then I thought better of it, and just lay back and bathed in the glory. Mmmmmh, glory :-)

- ~ -

Summary: First job at 1800hrs, cleared at hospital from our last job at 21:40hrs. Back to station, played around with my camera (see below), and went to bed at 0000hrs. Awoke at 0735hrs by the sound of the day crew arriving. Brilliant. Annual leave now - no more aussie ambo stories for a few weeks (but will catch up on other odds & sods)!

(not the best shots, but enjoy anyway!)

a different approach to thrombolysis

A neighbouring crew had a most peculiar job recently. Upon arrival, they found their patient complaining of classic cardiac signs: crushing central chest pain, cold, clammy and sweating like there is no tomorrow. Off comes the shirt, on go the defibrillator pads; ST depression is evident. Five minutes later, the patient goes in to cardiac arrest. A shock is administered, and the patient wakes up. Just like in the movies. And the ECG is also back to normal.

I saw the rhythm strip with my own eyes: sick rhythm - strange rhythm - VF - shock - near-normal sinus. We believe that in the process of defibrillation, the clot disintegrated or dislodged itself. I'll try and get a copy of the rhythm strip to post up here.

Tenecteplase? Who needs Tenecteplase?! :-)

I wasn't expecting some kind of spanish inquisition!

Called to an elderly Gentleman, lift assist only. On arrival, we check he has no injuries, lift him back in to bed, and make sure he doesn't want to come to hospital.

Ambo: You sure you didn't injure yourself, and you don't want to come to hospital?

Man: Yes, I'm sure.

Ambo: Good. If you did hurt yourself, that would be a completely different kettle of fish.

Man: What kind of fish?

Hmm, wasn't prepared for that one...

complicated communications

The dayshift had some challenges in it for me - all our patients were either demented, delirious or dead.

Included was one poor soul who burnt to death. Not a pretty sight, especially not for the bystanders who had seen the smoke and tried to help. There was nothing we could do for our patient, so after confirming this with our gear, we covered the patient with a blanket, and I took a look at the people standing around. With our initial patient having died in such a horrendous way, it was important to check on the members of the public to see how they were feeling.

I approached a lady who had an expression of fear and disbelief written all over her face. All I could do was offer her a seat in the ambulance, a chat and a glass of water. She seemed to pick herself up after a couple of minutes, and wanted to get on with her day. There was nothing more I could do, so I helped her out of the van and had another look around. Most people had left by now, but I had a chat to a few men standing around, who all declined any offers of help or seating. All that I could do now was paperwork and liaise with the other emergency services.

This job was up there in the top three of horrible jobs I've done so far. I would be lying if I wrote that it didn't affect me at all - it did. On the train going home that night I had to think about the job, not so much about the patient funnily enough, but the circumstances of it all. It was a sunny day, one of those days where you soak up the great weather and feel good all around, not expecting anything bad to happen at all. Then all of a sudden someone catches fire, and unsuspecting member of the public are drawn in to witness such a horrendous event, which may scar them for life. We as emergency responders expect to see these scene from time to time, even if we aren't immune to such sights. And the patients family?

It was more of a reflection of the job rather than feeling sad. I did not know the person. I did not see him die. We arrived and the the aftermath, no more, no less. Still, I doubt I'll ever forget that certain job.

Luckily I was working with a very understanding paramedic, and one with twenty years of experience. That job was also the first time that I had a good chat to my colleague about the situation. Just to talk about everything.

Attitude

Yesterday I visited the first year (pre-employment) paramedic students at university. I was invited by one of them to have a talk to them about next year, when they will be heading to induction school to start their practical training, and then after 13 long, hard, gruelling weeks they will be dumped in an ambulance to deal wth whatever the world feels like throwing at them.

Of course this is a slightly intimidating thought. What if I don't meet expectations? What happens when we get on road? How do you deal with shift work? How do you deal with bad jobs? Social Life?

All questions that I had myself 12 months ago, so I was more than happy to go up to campus and have a chat to next years group of newbie ambos. Actually, I was feeling a) excited to go up and share my recent knowledge and experience, and b) feeling honoured that they would ask me up.

I had organised to grab an ambulance from a close by depot to take to uni, to show to anybody who wanted to have a good look again. Ambulances are exciting to first years (to me they still are!).
So I head down to the depot to grab the van. I meet some colleagues, and of course they ask me what I am doing at the depot, wondering why I am in uniform 3 hours after finishing my nightshift. I explain my plans. Reactions range from "good on you", to "you doing that for no pay? Good on you (I wouldn't do that)".

Then one comment that gets me: "Why are you doing that? Let them figure it out themselves.".

Dumbfounded, I grabbed the van keys, and drove off, saddened by the fact that there are colleagues out there that just don't care.

no time!

Really Busy, no time to post, but heaps to write.
Watch this space...

expectations: met

I am now based at a outlying metro depot. For you urban types: I work in the sticks. Out in whoop whoop. End of the beaten track. Our next depot south is considered country.

So, what does a more city oriented lad like me think of that? Initially - stinks. Long way away from home, not much work, and transfers from local small hospital to big major hospital. Lower socio-economic population. And hopefully some big trauma on the long and windy roads. Also throw some remote properties in.

And all that was met in one night. Yeah :-)

- ~ -

How-to: Survive a shift in the regional areas of the flobach republic:

• Head to a Motorcycle vs Road. Apply spinal precautions to patient, just in case. Whilst driving back to hospital via extremely bone-shuddering road, slow down before you hit a wall of white cloud. Mist? No, hillbillies locals doing burnouts. Smell the freedom (or the rubber).
• Continue to an attempted suicide, polypharmaceutical (I love that word) overdose.
• Whilst at hospital, ask about above mentioned motorcyclist. Feel extremely happy that you exercised caution and went the whole hog with spinal precautions. Then transfer patient to major trauma hospital.
• Go for a romantic drive at night. Property at the end of the bitumen. Turn right in to a bumpy and grassy trail, open the wide gate that holds the horses in, avoid running over the rabbits. Try and shoo the sheep away, continue over the extremely bumpy dirt track and turn on all lights in order to try and find the house in question. Call your comms center to ask for more specific instructions on location of property. Notice that there is no radio or phone coverage. Continue around a couple more bends and bumps, find house! Park 50 meters away from the house, as further access is blocked by a big tree and accompanying branches. When walking in to house, relieve the suspense of "The Texas Chainsaw Massacre". No reply from calling "Ambulance"? Clench your sphincter and go inside the house. Fear the worst. Sigh when you see a harmless nonogenarian sitting in the hallway. Still chicken out when considering looking in the other dark rooms. When turning off the light in the room you just left, feel the stare of the invisible eyes bore in to your back. Wish that the patient would just want to leave all the lights on. Once outide, feel relieved.
• Get back to depot, and sleep until woken up by the day crew five hours later.

How to get out of a job schmoovely

Control: "flobachambulance, we have a female with a sore knee for you"

5 minutes later...

Control: "flobachambulance, we have a higher priority job for you, here you go"

Control: "otherambulance, please take over sore knee job"

3 minutes later...

Control: "flobachambulance, your job has been cancelled, you can head back to station."

Easy.

hammered

The nightshifts were awful. Two and a half reasons: Weekends night with good weather equal many jobs. Secondly, fewer vans in service (colleagues booking of sick). Half a reason: Full moon.

Jobwise we did a couple of unusual bits. We  had a RFDS transfer for a patient with a Sick Sinus Syndrome (SSS), which I am lead to believe is relatively rare, so that was a good one to see (and hear the ECG beeps). I chatted with the patient en route, both because he was a nice chap to talk to and also just to monitor his conscious state. The heart monitor beeped a very alarming and annoying tone occasionally during the trip - a long beep like you hear on TV when a patients heart stops, then followed by a rather upsetting two tone alarm. I was expecting to see a patient who was in the process of sudden cardiac death in front of me, but no, the machine was playing up. Phew.

Later on we got a call via one of those emergency at home push it yourself buttons for seniors, a patient with chest pain. Remember, this is the middle of the night, 2am to be precise, and noone answers to our knocks. Or calls. But the front door is unlocked. So alarm bells start ringing, and I slowly walk in to see...nothing. A lamp is on in the corner. On the coffee table lies a band aid wrapper, which stick out like a sore thumb in an otherwise neat and tidy house. Nobody. The nearby hallway is dark, a slight glow from the end. Damn, my torch is in the van.
I put my equipment on the ground before I venture in to the hallway, in my mind that frees up my hands to combat intruders, it also sheds a good ten kilos from my weight, making a quick run in the opposite direction far easier (much more likely than option #1, combat). Closed door number one...not going in there if I don't have to. Closed door number two, not going in there either if I don't have to. Door number three is slightly ajar, and a faint light is coming from around it, beckoning me towards it like some kind of holy beacon. I make myself noticed by loud shouts of "HELLO, AMBULANCE", but to no avail. I walk towards the door, have a peak, can't see anything. Pushing the door open a little more, I now don't think about intruders, but have a suspicion that my partner and I may be the only two living souls in this place. I dearly hope not, and I progress forwards. I see...a body in bed, a frail old dear, not moving. I'm starting to dread the worst. "Hello, Ambulance!"
She looks up. Phew. Turns out she was just having a kip, plus being stone deaf didn't help my case.
Treatment and transport is initiated, and a good time is had by all en route.

Oh, yes. We did have a kid who fell off a roof from 6+ meters height and only hurt his arm. Maybe we should be giving out alcohol as an injury prevention management tool.

Any thoughts?

Good Paramedic?

I remember, way back when, I was asked at my interview what my long term goals were. I replied:

"Successfully completing my prehospital training and being a good paramedic."

Since then, I have and still am striving towards excellence. I did pretty well at Uni in my first year, and am still going strong. I keep myself up to date with various online blogs, publications, articles in magazines and attend professional development seminars if they all on my rostered days off (or if I can get the days off). I talk to other students about their progress and what they have learnt. I ask paramedics about their experiences and what they would do in the same situation. I have some questions that I ask many different medics, just to get a broad range of answers for the same topic. Sometimes, I challenge them with my viewpoints, or with information I have grabbed from various sources, just to see their reactions and views.
I have squirted placebo medicine up my nose just to see what the feeling is like for patients, I let observers stick ECGs on my chest so I know how bloody much it hurts to rip them off a hairy chest again (and how cold electrodes can be).

Anyway, back to topic. Talking to colleagues on station you often come to talk about others as being 'good paramedics'. Or you swap information with fellow students about their tutors; "how is your tutor?" "Yeah, he's a good paramedic". Or you look on the roster who you are going to work with next, or you are assigned a replacement partner for next week, and you ask colleagues if they know him or her. "Yeah, they're alright, he/she is a good paramedic."

I am forming a follow up post with my views and opinions on this particular topic, but for now it's over to you. No matter who you are, what background you are from...

I ask YOU, dear reader: what is a "good paramedic"?

Slowest shifts: observers curse

There is a thing amongst ambos, it's called karma (yes, that's right - the one that ran over your dogma).
You want big things to happen, and all you get in transfers.

I have been waiting in despair for weeks for a decent job. Something I haven't done before, that may test my skills. Not much of that been happening, unfortunately.

Yesterday was a slow day. Didn't hit the lights or sirens once. Outstanding job was a gentleman who had a swollen finger. For one month. Poor fellow didn't call us, his nursing home staff did...oh well, part of the job. Five jobs in all.

Today was the slowest day so far at my current depot. I wanted something interesting to happen, desperately. We had a first year student on board with us (full time uni student), and I was keen to show him some action. After sitting at the depot for three hours, we finally got...a transfer. We did get a mildly interesting spider bite job after that, but continued on with sitting at the depot.

So student and myself go outside, have some more chats, play with the equipment. I had given up all hope for a good day. And the beep goes off. Ooh, priority 1, at least we get to show off our lights and sirens. Ooh, a car rollover, even more exciting! Patient trapped...I silently grin to myself, but then a slight bout of panic grips the back part of my mind. What do I do? OK, remember their breathing. Airway first. A to E. Scene safety. Safety goggle. Are the police already on scene? Is the fire brigade already their? What are the injuries? Blood? Other people involved? What about thisthattheother? For the first time in weeks my heart starts racing.

Upon arrival, there is a car on it's side, surrounded by water fairies (fireies) and cops blocking the road. Some firies have already crawled in to the car. Our patient is technically trapped...because she can't open her drivers side door. Of course not, the car is lying on it. So I smile to her through the front windscreen, say hello and rudely get taken out by the windscreen wipers who have no sense of authority at all.

To cut a long story short: it looked worse than it was, but we took all spinal precautions to be sure, to be sure.

Having an extra set of hands on board was excellent too, I could sit in the corner of the ambulance and establish command, barking out orders of "another blood pressure please", "could you stick the ECG on please" and "let's get a blood sugar!". Excellent. That gave me time to kick back, remember that trauma patients should be kept warm and stick a blanket on her.

End of the story: I like keen students. They are an excellent pair of hands, and every job is something new for them, What may seem boring and routine for a seasoned paramedic is all exciting and different for a student. Like me. After 6 months things are still exciting. And being able to share that feeling with others is awesome.

Bring on the students!