flobach republic

Moved!

2011-01-28T11:06:00.000+08:00

Hello dear reader,
The Republic has moved. You can now follow everything on

http://flobach.com

Not only have I moved, but I have also joined the EMS Blogs Network.
No change really, apart from a different theme, yours truly trying to keep you up to date with some of my thoughts, but being amongst some other great writers out there (here are the other networked blogs: http://emsblogs.com/blogs/)

Making friends is easy

2011-01-04T14:41:00.001+08:00

We take over from the night crew, who tell us that one of them had struck lucky with a dimensionally challenged and visually challenging member of the nursing home staff.

A little something like this:

Staff: You might need this (hands over emesis bag)

Ambo: Why? We have plenty in the truck!

Staff: No, I really think you need this. I'm sure it's about the right size condom for you! *winks*

Merry fornicating Christmas to you too

2010-12-27T15:07:00.000+08:00

In my books, if I invite anybody over to my place, be it for friends for drink or some poor sods who have to work over christmas in order to help you with your oh-so-bad-back pain, please do not criticise their attire, especially since the latter group generally has no say in to their choice of cloth.

Envisage following scene:

(enter big person who has just got up from the toilet, walked through the bathroom door and is standing in front of us):

pain Pain PAIN! I can't walk, I can's sit, I can't even get up when I'm on the toilet. My back hurts. Really bad. Horribly bad. Do something. And what are you wearing? Is that your new uniform? It's horrible!

(enter the aghast, hollow and echoing mind of the flobach)

...horrible...orrible...rrible...rible...ible...ble...le..e...

(enter the face.etc. motor control bit of the flobachbrain)

Right everyone, we need to pull up the sides of those lips, scrunch those eyes a little to get a professional and positive scenario going on here! C'mon muscles, get to it! And tell that voicebox to get some lame joke happening, pronto!

Sounds like everything went smooth? Yes, everything except for the trip to hospital.
I may have aimed for every gutter and pothole until we got there.

Oops.

(and read this if you already haven't)

The living dead

2010-12-15T14:12:00.000+08:00

(via: http://www.royalbritannia.hu/art_3.htm)

Reading this which was inspired by this made me write this post.

Enough confusion.

Years ago, when I was doing my mandatory civil service (Germany still has conscription, and instead of going to the army I opted for the cushy way) I was a simple disabled taxi driver: driving taxis for the disabled mind you, not being disabled myself or driving a taxi that was disabled (although some of the vans were on there best way to scrap metal heaven).

Happily cruising through my day the next job was a simple home pick up to take an elderly gentleman to his dialysis appointment. He didn't look happy. In fact, he looked a bit like a bulldog - no facial hair, saggy cheeks, rounded head. Wheelchair bound, he looked at me with hollowed eyes, grumpy, sad.

Of course I walked in with a cheery "How are you going this morning?!", which was met by a nonchalant grunt (told you, bulldog). In the lift down to the ground floor, I tried to make conversation, blah, blah, but it ended abruptly when he answered my question of what is going on.

"I just want to die."

"Hmm" I thought to myself. No response came to mind. No response would ever come to my mind. How do you deal with someone who has no family around, who is stuck to a chair on wheels, who lives a confined life in a crumbling shell (body), but who's senses (mind) are still sharp, if somewhat depressed?

He was the first of a few patients, both then and in my current job that I have come across that have expressed their will to die. Many others I assume would have expressed this wish to me as well, if they had not been in a situation of severe dementia, unable to speak, doubly incontinent and bed ridden.

For the first group, I recently met up with our ambulance chaplain, and brought up just that point, and how I always feel so helpless and speechless. He did acknowledge the difficulty of talking about such an issue, and recommend I should try using a little reverse engineering: Get them to share memories of their 'good old days', when they had friends & family a plenty around them. This should hopefully cheer them up if done properly, plus it may breathe new life in to trying to establish new relationships and overall enjoy life a little.

As for the second group, I reckon a little reverse engineering would be appropriate to: Instead of life saving interventions, some life ending interventions would be the most humane thing society could do for these poor souls.

Thoughts?

Registered Incompetence

2010-12-12T10:03:00.000+08:00

We got hammered last night, job after job after job.

Great when some nursing home colleagues are happy to assist you with your patient, stating that "she normally isn't like this", and that her medications aren't working, and everything is going downhill, and she needs hospital, patient is really breathing fast and blah blah blah. I would like to share the following conversation snippet between me and the RN:

Me: So, this patient is usually GCS 14, then?

RN: What? Huh? *scuffle* Hospital! Worsening!

Me: Beverly, your resident, does she normally present with GCS 14?

RN: What? Huh? What's GSC?

At this stage my colleague had to leave the room, and I heard heard versus wall banging from outside. I popped our confused, anxious, dazed and hyperventilating patient on our stretcher, wheeled her out in to safety, and magically she calmed down, had nothing majorly wrong with her, and was quite pleasant, if somewhat confused...as it said in the nursing notes.

And to think she is in charge of peoples mums and dads out there...horrible.

The December Handover would like your input

2010-12-11T13:25:00.000+08:00

Well, since I've gotten in to this Handover thingamajig, we'd better keep it rolling!

Pop by to Just my Blog and submit your chrissie stories!

2010-12-08T10:24:00.000+08:00

My service recently aired a TV advertisement as part of a big recruitment push:

Naturally, it has caused some discussion. First time I watched it, I was left hanging. Wow, it's really short...too short. Was that it? Is that all we do, put blankets around people? What about all the sexy skills we have, sticking things in to people, driving on the wrong side of the road, checking peoples ECGs. That would attract a few more people.
I believe the producers/writers/company wanted to epitomize what being a paramedic essentially is: someone who cares for the sick or injured. And offering someone understanding and a warm blanket after a rollover on a major road s just that. Probably not the approach I would have taken, but it does boil it down to the essentials.

But the clip wasn't intended for me, it was intended for members of the public who are (or should become) interested in joining the profession. Hope it hits the spot, we need more staff!

I won't comment on vehicle placement, how crowded the scene is etc etc...it's a promo video and it it supposed to look like an accident, the public wouldn't have a clue about tactics (then again, it would have been nice to incorporate such realism in to the video)

- ~ -

That may have sounded negative, it wasn't entirely. Just not what I had expected. So...let us have a look what other services have done to promote themselves

From Milano, Italy comes AREU, the local ambulance service.

I quite like this one, more action packed. Then again, this may recruit the wrong type of people (maybe the first clip is more likely to appeal to and recruit caring people?). This one is also a little more realistic, with the ambos grabbing all their gear, scuffling up the stairs and checking a response for the patient, and actually medically treating the patient (you can't cure everything with reassurance, you know). And Kudos to the kid who called 118 (ambulance emergency number in Italy), and despite not understanding Italian, you can hear the dispatcher congratulating the kid at the end of the clip with a clear "Bravissimo!". Thumbs up.

Denver EMS:

Denver EMS took a different approach again. A mini series, no visual action, but stories told. What it is like to be a paramedic. What to expect. The guts, the glory, the ups, the downs.
I really like them. And I dig the music, too.

The others clips:
Commercial #2
Commercial #3
Commercial #4
Commercial #5
Commercial #6
Commercial #7

- ~ -

So, there we have it. Three recruitment video from three different continents with three different takes. What is your favourite, what service would you want to work for after viewing these ads?

Please comment in the comment section below!

And a final laugh! Found this whilst browsing for vids...hehe: http://www.youtube.com/watch?v=CNZtpTc8eH8

The Handover, #21

2010-12-06T15:39:00.001+08:00

Burnout.

I had a recent rant (see my earlier post), and so have a few other bloggers out there.

Go see for yourself what everyone has contributed!

And take a break every now and again.

Just one look

2010-11-23T19:44:00.000+08:00

Just one look is all it takes, they say, for an experienced paramedic to realise if the patient is "big sick" or only "little sick", if the patient is time critical or a time waster.

Just one look is all it takes for a jaded, cynical & no fun to work with paramedic to annoy the fuck out of me. Sorry for the harsh language, but it really annoys me when people look at the job description, and consistently fob it off as the patient being a time waster.

I don't f&^%ing care, I'll see for myself. We all know that dispatch information is unreliable. And occasionally, the patient who has had constipation for three days and is complaining of a little tummy pain failed to mention the chest pains he is having - bang, there's your 'genuine' patient. But even then that burnt out paramedic will not accept that as a wake up call, more of a 'oh, happened to be a real patient for a change, meh'.

FFS, be enthusiastic about the whole thing. And I'm not talking about girly screams and wishing every patient be involved in major trauma and having massive myocardial infarctions. Just take things serious enough, have some fun, a get some satisfaction and excitement out of it.

I am absolutely over with this awesome job being treated as more daily boring stuff, more everyday boredom, more drab, everybody is there to get me down.

Get out of that horrible cycle, splash some cold water on to your face, slap yourself hard, get back to the days to when you were excited everytime you got a call, no matter what it was.

This job, this life is about enjoying yourself as much it is as helping others enjoy their lives as much as possible.

Do it together. And if you want to go down, get out. Don't pull me with you.

Coz I'm here to have a party.

The October Handover - Wearing is Caring!

2010-11-18T16:14:00.001+08:00

Another month has passed by on planet earth - which means it is time for another edition (number 20!) of "The Handover"!

This time we wanted to find out what everyone wears whilst they're on the job...uniforms, gadgets, the lot. Thanks for all who contributed!

We'll start off nice and casual with EMS Chick, who has the liberty of wearing what she wishes at work. Well, suspenders would be taking it too far I believe, but read for yourself:
http://emschick9.blogspot.com/2010/10/pockets-but-i-have-rookies.html

Cruising along the volunteer highway, let's have a look at how to save for a hot tub. I believe this is ancient ninja technique: a) remove spare change from pockets in order to be able to move stealth-like towards your opponent, and b) wear a ballistic vest for an extra super mario life. Is EMS really that dangerous up there?
http://justmejustmyblog.blogspot.com/2010/10/pockets-jingling.html

Jonathan B takes variety to a new level...from uniform over evening dress to...boy scout uniform? Hell, that's way cooler than I'll ever get to dress up when going on calls. Honestly, I would pay to see that. Kinda kinky too ;-)
http://jonemtp.blogspot.com/2010/10/things-i-carry.html

Follow the accessory maturation process of a EMT-P (P for Primate this time), over at Life of a Transport Monkey. Like the evolution, keeping it down to the minimum as you realise you don't need everything. Going through that process myself (no offence to those who carry more though!).
http://transportjockey.com/2010/10/21/are-those-shears-in-your-pocket-my-handover-post/

The Ditch Doctor takes it to an even leaner level. And I have to quote his three main items: "education, clinical knowledge & experience". Well said, Jonathan.
http://futureditchdoctor.com/2010/10/20/my-handover-submission-wearing-is-caring/

Firing it up again, Ronnie swings us a 180, and explains why he does like to carry equipment on his person.
http://gatesofintegrity.blogspot.com/2010/01/on-duty.html

James Chadbourne, a.k.a. mack505 shares great ways how to fight the obesity pandemic that is currently flooding the western world: Empty your pockets!
http://notesfrommosquitohill.com/2010/02/im-not-overweight-im-overequipped.html

Last but not least, InsomniacMedic takes an entirely different approach on the subject. I really like the post, and can't sum it up nicely, so please just have a read yourself. And don't forget that we are all human at the end of the day.
http://insomniacmedic.blogspot.com/2010/06/suit-of-armour.html

- ~ -

And so to answer Transport Monkeys question: I don't carry shears in my pants pocket. I'm happy to see you guys and gals contributing here.

Sorry for the long wait. I'd nearly finished typing up version 1 when the interwebz went kerbonkers on me, and lost everything in the ether. Exams came and went, and finally I sit myself down now in between night shifts to re-wrte everything. So many apologies if this read a little twisted/warped. Purely (un)intentional.

A dream.

2010-11-11T20:36:00.000+08:00

http://www.minimalfreaks.com/marc-houle-licking-skin/

Second night shift.

We finally head back to the depot in the deep, dark hours of the night. Pfffffftttt, I let myself fall on to the recliner, my dead weight heavily pushing out all the air previously trapped under the faux leather covers. Click click crunch, up goes the footrest. Squeeaaak, down goes the backrest. The chair, although rickety, comfily mould to my tired body, and soon I drift off to...

...the back of the ambulance. I am sitting in the attendance seat, an elderly gentleman on the stretcher beside me. Full treatment is on the way, hooked up to the ECG, IV's running, SpO2 probe on. He is topless, his skin is a pale, mottled, sickly colour. An 'Eau de Old' fills the air, wafting from his pores, his vaguely active sweat glands covering his skin in slippery moisture.

All of a sudden his arm is in front of my face. Is he angry? Is he attacking me? What is wrong?

I open my mouth, lick his arm, and then half-heartedly bite it as it accidentally (or incidentally?) moves towards me. Salty sweat and weeks of neglected personal hygiene mix on my taste buds to an utterly indescribable taste that immediately makes me dash to the back door of the van where our cleaning equipment is kept. I grab some Isowipes and hastily wipe my mouth out, the salty-stale taste making way for an overpowering disinfectantly, alcoholic clean taste. In order to completely get rid of all yukkybugs I douse my tongue, gums and teeth with alcohol based hand cleaner, images running through my head similar to Mr. Bean covering his tongue in out of date oysters (video from minute 2:38).

Yet the images of flaky, pale skin and the musty taste persist. My body twists and turns, my stomach cramps up in disgust, and...three hours later the alarm goes off for another job.

What a strange dream indeed.

Duet

2010-11-10T08:23:00.000+08:00

It is 0630hrs in the Emergency Department. We have been working without rest since 1800hrs the previous day. No acute emergency work, just steady, chronic malaise of the population.

Right now, we are standing next to a deaf old dear in the corridor who we will take home to a nursing home. An agency nurse (AN) sees us (US) standing there and starts asking questions:

AN: Are you guys the day or the night crew?

US (grunting, in unison): night.

AN: You do long shift hours. 12 hour nights?

US (grunting, in unison): fourteen.

AN: Wow, you guys must be tired then!

US (grunting, in unison): yes.

AN: How long are your day shifts?

US (grunting, in unison): ten

AN left us alone after that. In retrospect I did like that my partner (on overtime, never met him before) and I responded so well together (pun intended).

Beyond the back yard

2010-10-12T13:38:00.000+08:00

Recently, I've had a thought or two in regards to the interface of ambulance staff and hospital staff, i.e. handing a patient over. Once particular point that I wanted sorted out was what the hospital based staff wanted to hear from us, so I could adjust my practices accordingly.

Well, it's not that easy. To part quote Dirty Harry: "Opinions are like assholes, everyone has one". Some want this done, some want that information included, but most are just happy with whatever you give them.

So I went on a little hunt, and grabbed a hospital "Emergency Chest Pain Assessment Pathway" form. It's an A4 leaflet (four pages) with all triage, assessment, history, medications and you name it conveniently written down in one form. Everything the hospital does assesses when they are presented with a patient complaining of chest pain.

I'm not sure where I stand i regards to copyright etc so I won't publish it, but here is the complete document how WA Health ACS Models of Care in pdf. extensive, but good to have a browse if you happen to work in Western Australia (and yes, they recommend 12 lead ECGs for the ambulance service...surprise surprise!)

So, the next time you are at your local Emergency Department, pop down to to the paperwork section, ask some staff about it and see if you can find some info to learn off. I'm going to sit down for a couple of minutes and do just that :-)

Pocket Rockets

2010-10-10T11:48:00.000+08:00

Since we recently got new uniforms, I thought it would be a good time to have a look at what we carry with us and on us during our shift.
This is not a new idea I must point out, check out these two older posts for the full history

Oh, and this is my contribution to The Handover, October 2010

- ~ -

My uniform, in its basic setup (no vest or jacket, no additional pouches) has 9 or 10 pockets (depending if I am wearing the jumpsuit or the two-piece).

Here is what I carry with me on a daily basis:

On arms: ball point pens: pens are awesome. You can write with them, you can reset calculators with them, you can use them for self defence if you're desperate. I usually carry in order to have a spare or two (a. hand to a relative t fill out some patient details whilst we are treating, b. in case they don't return it and I need a pen on my next job, and c. if my colleague forgets his…)
And a pupil light.

breast pockets: stay empty as of yet, I have found nothing to put in them. During the shift they get used to temporarily store stuff (med vials, patient details…all whilst moving the patient around so they don't get lost).

Waist/thigh pockets (you know, the ones you stick your hands in when its cold)
left: is the rubbish pocket. All on scene rubbish (as long as its clean and not sharp, e.g. plastic packaging) gets stuffed in that pocket, for disposal later at hospital or the depot. I don't like to leave the patient with rubbish if possible. All sharps go in the sharps bin, all dirty or wet things (alcowipes etc) go directly to a bin where possible)

right: If I come across coins for some reason or another, they go in here. I generally hate coins, and never start a day with them in my pocket.

cargo pockets
left: all my personal stuff: phone, wallet, house keys (and car keys if I happen to have driven to work that day). I am not trusting enough to leave them at the depot (although others blatantly leave their 1500$ laptop lying around…). Plus, you never know when you need them.

Right: Ambulance related stuff: Patient detail forms (hand to relatives to get some information), drugs protocol reminder card (adult and paeds dosages), what does this drug do card (the mini analogue version of Epocrates really), and a little green booklet with a few other ambulance related things).

In addition, I have my medium sized pouch clipped to my belt on the left, with 2-3 pairs of gloves, trauma shears, mini mag light, won-baker pain scale (only used twice in 18 months….should remember I have it there. When i used it it was really handy though).
Plus a permanent black marker (you never know, plus there was space left) and a whiteboard marker (write little notes on the window of your ambulance, e.g. a list of items to restock).

On my right belt side I have a mag light hoop thingy that will hold a 3 cell mag light (service issue). I always have a set of ambulance keys hooked to them, that then hang in my pocket (I can't stand hanging them from belt loops, they hang to high and rattle around, and make you look like and absolute try hard prick).

Anything else? I carry a few items in my kit bag, but nothing out of the ordinary (hi viz vest, cap with clip on LED lights, something to read in case we get ramped, spare pens).

What do you carry on you when at work?

The Handover - Wearing is Caring!

2010-10-10T10:00:00.004+08:00

Here I am, trying to become more regular...you know, more fibre in your diet and...erm, I mean more ~~bog~~ blog posting...

So I've teamed up with the wonderful troupe down at The Handover for this months Handover...

*insert drumroll*

"WEARING IS CARING"

Tell us what you wear to work; your uniform, your gadgets, even trusty friends like Simon the Sturgeon (a colleagues stuffed fish who always rides on the dashboard).
Or Geoffrey.

So - write up a post, or start a blog if you need to (with blogger.com, wordpress.com or any other popular blogging platform) and send me the link of your post to me:

flobach at gmail dot com

Deadline is 30th of October, so get cracking and writing!

Here's my post, something to get started on (but by no means a guideline - get creative, people!).

Cheers in advance for you contributions, and a big hooray for the blokes who started and continue to look after the handover!

Wear art thou?

2010-10-09T12:00:00.001+08:00

Back in the day...

Recently, our ambulance service treated us all to a uniform update.

The old uniforms had been around for over ten years, and were outdated in terms of style, functionality and visibility (that would mean that they were stylish and functional at one stage...no comment on that).

So we went from a 'dress' uniform (no, not wearing dresses) with dark green pleated pants and light mint green (horrible) pressed shirts to a more tactical style uniform - much better!

The benefits in my humble opinion

the dark green/teal does not show up stains (although it does attract white hospital linen fluff)
the uniform represents our workplace environment (less office, more outdoor)
the breast pockets velcro open, no more fiddling with unbuttoning them and having everything fall out when bending over
no more epaulettes, rank on breast patch and on back patch. No more stuff getting caught on your shoulders, no more fiddling them on new shirts; also makes for a cleaner look.
name (left) and rank (right) on little velcro patches, no more stab wounds from those bloody name badges
pen pouches on sleeves
Cargo pants - big pockets with velcro for stowing heaps of stuff and accessing it easily.
Reflective stripes on pants, reflective piping throughout uniform, relfective rank patch on back, reflective name and rank patch on front.
much more rugged (it seems) material, with mesh underarms and mesh flap on back (great in 40+ degree Perth summers)
Overall fit is much better, and looks nicer on staff (the old stuff was baggy where it shouldn't have been, and tight where it was inappropriate).

Oh, and the best? We get Jumpsuits….yeah baby! Love 'em!

What are your uniforms like? Have you recently changed or are you going to change?
Interested to hear about your rants, raves, preferences and improvements!

Scholarship for the ACAP Conference

2010-09-16T16:06:00.001+08:00

A little something that may encourage you to come over to sunny Perth for next months conference!

Applications are now open for financial ACAP WA members to apply for the 2010 Kevin Milton Smith Scholarship to attend the 2010 ACAP Conference at the Sheraton Hotel Perth.

As the 2010 ACAP Conference is held in Perth, 10 scholarships will be awarded which will cover the Conference Registration fee, the Welcome reception and Clinical Simulation or Triage Workshop.

Please direct all 2010 Scholarship queries to Blaise.Rego@wa.ambulance.net.au

Australian College of Ambulance Professionals
WA Branch Inc
E: secretary@wa.acap.org.au
A: PO Box 335 Belmont WA 6753
W: www.acap.org.au

Automatic Recognition

2010-09-15T15:35:00.000+08:00

We are at a nursing home, Patient bundled up on stretcher, heading off down the corridor.

A visitor sees us going past, and exclaims: "that's my mother!"

We stop, said visitor has a closer look, and realizes that no, our patient is not her mother.

"I thought she looked like my mum, she had white hair!"

A rare occasion in a nursing home...

You Define, We Whine...

2010-09-10T09:11:00.000+08:00

Well, I felt like it was time for a rhyme. Or as a colleague put it:

I'm a poet

and I don't even know it

- ~ - Finish Interlude - ~ -

Taking my last few posts further, here's my take on Steve Whiteheads comment (from the ever great EMT Spot):

Quote #1:

I think the idea that people call 911 out of ignorance is a flawed analysis. People call 911 inappropriately for two reasons.

1.) They have reached the end of their problem solving capability and need help. They don’t care if they are misusing the system. They care about getting help because they don’t know what to do. In their mind, that is an emergency.

2.) They are purposefully abusing the system for personal gain. Whether it is for controlled medications, in-home health care, a ride to somewhere closer to the hospital, attention, a warm bed or food, they want something that we provide and they don’t care if they have to game the system to get it.

I believe there is a group in between, 1.5 so to say: People who undeniably need help. They need advice. They need someone, but not us. They just don't know that yet.

Our Comms/Control/Dispatch should control and filter these calls out, and divert them to appropriate resources (paramedic practitioner, hospital at home, telephone advice, GP, psych services, talking clock.)

And as pointed out on my last post, it would help for all health professionals to work together, know what to expect from each other, and know how to use the other agencies resources appropriately. A great step forward for paramedicine would be to be recognised as a profession (registration in Australia, hint hint.)

Quote #2:

Notice something about both of these types of people. They both have a basic understanding of the 911 system. Educating them further on the appropriate use of 911 will not prevent their next call. Even if you could stop them from calling, their problems are so common that their will almost certainly be a new person to call tomorrow instead of them. And the process begins again.

As I stated above, education for caller type 1.5 will help. You can do your bit, it won't change the world, but we gotta work on it together. Sure the big changes have to occur on a management level, but we're the road warriors actually talking face to face to the people.

So in a way, we're all asking for the same thing: More options, or tools as Steve calls them. The bottom line remains: Our current model of 'send an ambulance out for everything and treat at ED/ER/A+E' is outdated (and too costly).

Apart from those minor points I don't agree with, a brilliant (I really mean brilliant) post by Steve.

I just wish more of our breed would adopt such attitudes.

Something for the locals...

2010-09-08T12:10:00.002+08:00

ACAP and Royal Perth Hospital are teaming up together again for this years

Western Australian Trauma Symposium

on the

6th of November 2010.

Registrations are open now, earlybird closes on 30th September.

Dr Tony Smith, the Medical Director for St John Ambulance New Zealand, will be the keynote speaker.

Topics include Prehospital, Military and Rural Trauma Management, the aftermath of Disaster Management and Issues pertaining to Trauma Training

For more info go to the ACAP website:
http://www.acap.org.au/news/wa/wa-state-trauma-symposium/

Alternatives, pt II

2010-09-06T10:00:00.001+08:00

Something I didn't consider in my previous post was the incompetence and lack of knowledge / laziness of other health professionals.

We picked up a bloke the other day who had been seen by his GP for an ongoing chest infection. The prescribed drugs weren't kicking in, so a couple of days and a few more visits later our patient is sent home again with no new treatment.
The patient calls the surgery again, stating the not improving condition, and wants to make another appointment.

The reply from the other end of the phone line? Call an ambulance, and go to hospital.

After all, we still are DFAs.

Someone loves me!

2010-09-05T09:26:00.000+08:00

Thanks to the people over at Medical Assistent.net for featuring this blog in their top 50 EMS blogs.
Looks like a bit of a generic site design wise, but hey, some random number generator picked me, so I feel good :-)

Service

2010-09-04T18:06:00.001+08:00

I recently ordered a sandwich at a cafe. Nothing fancy, but the waiter was friendly.
Halfway through my meal, some of the staff slowly started packing together the outside furniture. The waiter must have realized that I (unintentionally) was speeding up with eating, and reassured that there was no hurry, and I should take my time.

The best part came when I asked what time they close: "it doesn't matter. You take your time."

What a brilliant answer. I will be going back there. They all seemed really happy when I complimented them on their great service too.

Goes to show, you can learn a lesson from anybody.

Alternatives

2010-08-12T11:49:00.002+08:00

To all us paramedic types: Who hasn't arrived at a patient to find out their call was not appropriate for the ambulance service? Thought so!

Two things I would like to discuss:
One: Alternatives. In the area where I work there aren't too many. A lot of GP clinics don't take new patients, the standard of treatment can be very average. At night time, getting hold of a GP is even trickier, heading towards impossible. Out of hospital services (hospital at home, nurse practitioners) are just in their infancy and not widely spread. Paramedic practitioners do not exist, and judging by the current environment it may be quite some time until they do arrive (if at all).
Point being: a lot of the times people don't know where to turn to, so they just call an ambulance. You might be their only choice.
Two: Due to the above, it has become a mindset to call an ambulance. Not only for transport, but for advice on the current situation. Unfortunately, not much of our training is directed towards advice, neither are our guidelines. (You come? Hop on! You stay? Sign here!)
BUT - This is the very situation where we have the chance to change things and show the public that we a professionals, and not mere transport monkeys.
That 13year old girl with 'DIB/SOB' (difficulty in breathing, shortness of breath) due to a massive asthma attack who gets a lights and sirens response? Yep, on arrival she has a cold, nothing more, but thats part of the job. Sure, her mum may have exaggerated over the phone to get us there quicker, she also may have unintentionally said all the right keywords (AMPDS or not). Either way both of them should be told (not told off) when to dial 000/112/999/911, and when not. The next time they don't call you at 3am for a manflu you may not know it, but you or a colleague will be thankful for one call less that night...
I know there is no easy fix. There will always be people who will call an ambulance for the most minor of ailments, no matter how much you ~~hit them on the head with a sledgehammer~~ educate them. On the other side of the fence, people will still continue to ignore chest pains and refuse ambulance transport although their need is more than genuine. We can't do much about these extremes...but for all cases in between, it's not only up to the system to educate people how to use the service correctly, it's up to us. We are part of the system, after all!

So, what can we do? We should familiarise ourselves with alternative healthcare pathways, pass on this information to patients who may potentially benefit from such and encourage them to use them - appropriately. Talk to the staff at your local hospital what they might know, and find out what they tell people who self present to ED. Browse the net, especially the government websites (aged & disability care), additionally any private healthcare providers who may work closely with the government to provide a service.

- ~ -

Feedback please! Let me know how you deal with such situations, what alternative pathways you have, and any improvements (both ambulance and hospital) that have been implemented in your area.

P.S.: Thanks to Ross Hendry (twitter: @ross71521) for pointing out that The Happy Medic wrote a similarly themed blog post recently: http://bit.ly/cwHIUc

My Folder

2010-07-29T10:49:00.003+08:00

My Folder.

Comes with me to every job, gets to know all my patient details, get flung around in the back of the van, falls on the floor, spills its contents around, only to be picked up by an angry owner (me) and getting shoved back together in one place. It's predecessor was green (funky!), but sadly died a slow death of maltreatment. Everyday office folders aren't made for everyday ambulance abuse I guess.

Anyway, point to be made is the content. Have a look at the inside sleeve, that's my main reminder of what I want to write on my Patient Care Record form, on the other side is a quick trauma assessment sheet.

This is the Main Page:

Crafted and finetuned after 15 months of experience (with hopefully many more years to come!), continually added information as experience expands, this is the heart and sole of my paperwork. Generally the procedure consists of doing a job, documenting as much as possible and needed, handing over at hospital, remembering questions that I had no answer for (I once forgot to check for a tonguebite and incontinence in a seizure patient). These improvements make their way on to the sheet, which eventually make their way in to my brain, sheet more of a backup plan for doozy days or 3am jobs. Only recently (3-4 weeks ago) did I add the OPQRST to my repertoire, which has made Chest Pain and Abdo Pain calls much easier, asking the right questions and getting the documentation right the first time.

To keep posts short (yep Taz, this is for you :), I'll divide my folder explanation up in to two posts.

What do you guys carry around in your folder? Any tips/tricks/hints I could add?

Feel free to use my template (please don't forget to credit me). I can send you a PDF/word/pages version of the document if you like, just let me know in the comments (can only upload pics to blogger).

Reflective Practice

2010-07-19T16:56:00.000+08:00

Registration for Paramedics....ooh, this could be a long post!

But it won't be, as I have to get some last minute uni work out of the way.

So, instead a quick message and question. I have just signed up to http://www.cpdme.com/ in order to keep my portfolio a) online and b) current, hoping this will make things easier to write down some reflective practice stuff. I was getting a bit antsy about sharing callouts on this site, this should make it a wee bit easier.

How do you reflect? Informal process, writing stuff down, keeping diaries, logbooks, writing things in sand, talking to peers, talking to goats, dictating it to your secretary?

Registration is on its way (in Australia), it is only a matter of when, not if. I'll be ready with a bunch of stuff locked away online for that time...just need to get in to the habit of writing things down in the right place!

Working Holiday

2010-06-30T09:16:00.001+08:00

Not working, but a holiday with a lot of ambulance involvement. Only in dot form, as I am sitting in the Library in Flinders Lane, and need to get some things done later.

Met with my first on road tutor and great mate
Met with Taz, from http://taztheambo.blogspot.com
Met with some paramedics from Paddington Station, who were kind enough to show us around
Grabbed some dumplings for dinner last night, had to share a table as it was so full. Turns out is was a ED nurse from one of the local hospital. Random Cool :-)
Going on an observer shift with a Melbourne crew tomorrow
ACAP SPA conference Friday

...and living in a hostel is a little different, I am reminded. My locker seems to have come directly from the Rotterdam drug seizing authority. I opened it yesterday and nearly started flying around the room in a green haze, such was the pungent stench of Marihuana. I am now worried my clothes will soak up all the THC particles, and I will reek of weed on my flight home. Police will arrest me, lock me up and perform a deep and thorough full body cavity search.

Oh, and I wanted to share the view from my room:

PS: Girl in Green, where art thou? No escaping Squeezy....you said you were coming to the conference!

Germany

2010-06-20T13:35:00.000+08:00

No, don't mention the world cup....please....

I just stumbled upon a colleague from Wiesbaden, close to where I used to live in Germany.

Anyway, he has written up two great little posts how the Ambulance Service works over there:

EMS in Germany
EMS in Germany, Part II

Having operated in both countries, I could add a few more experiences and differences from my perspective. But I won't. I'm on nights tonight, and I'm going to sleep now.

Otherwise I will be an Insomniacmedic (thanks for the link!)

a transfer

2010-06-18T21:46:00.000+08:00

Teenager, transfer from little hospital to big hospital. Big hurt -> Morphine -> No hurt.

At little hospital, I have one hand on the rails of the bed. Our patient starts stroking my gloved hand with one finger, with a big grin.

---

We arrive at big hospital. Patient looks up, points at me, and says:

"You're cool. I like you" *massive grin*

To which I reply:

"Nah, nobody thinks I'm cool. That's just the morphine."

To which our patient turns to his mother:

"MUUUUM!!! Can you get me some Morphine for home please? "

Plans

2010-06-17T21:25:00.002+08:00

This semester is done and dusted.

YEEESSSSIIRREEEE!!!!!!!!

Right, what will I do in my few weeks of Uni break? Let my mind run free, and take a plan to Sydney to see some people (and hopefully the almighty TAZ if he has some spare time...). Then it's down to Melbourne for the ACAP SPA Conference (beware, three different links).

So: If you are in Sydney or Melbourne, reading this, and feel like catching up with a toorist from da west - gi'us a shout!

And when I have returned, it will be time for this baby to spring back in to action...

- the lean mean green machine -

my job

2010-06-07T21:01:00.003+08:00

~ - ~

Recently, I was at Ambulance HQ for some further training. I had my uniform on, whilst getting out the car a fellow got out of his car next to me. "You guys do an excellent job!" he stated, adding a few more compliments to the monologue. All I could stammer was "Ah, its an easygoing job, cheers, good fun, nice to meet you, thanks, good bye". Talk about an inadequate answer….

I felt silly after that. There he was, Joe Blow, thanking me, Yours Truly. Saying thanks on behalf of the public to my profession. And i wipe it away, play it down as if it were some kind of game, not worthy of mentioning.

Not long ago, a colleague unfortunately had the 'pleasure' of seeing the other side of the Emergency Department - as a patient. During treatment and assessment, the doctor walked up to my colleague and stated "I couldn't do your job".

Sure, our workspace may be a little volatile at times, strewn with uncertainty. Sometimes outnumbered, sometimes running out of hands. There we stand, in front of whoever called us for whatever reason. We stand in their world, but have to tell them that they now have to play by our rules. Need a hand? Call another crew, wait 5-50 minutes. Patient lying awkwardly in the bathroom? It might be awkward getting him or her out. Hasn't flushed the toilet? Might be a little smelly. Didn't quite hit the toilet bowl? Makes extrication easier, as the floor is already slippery.

But it beats having to go to work five out of seven days to an office, seeing the same people again and again, and sitting on yer bum staring at a screen.

Chances are, I couldn't do your job either.

"You must see some horrible things"

"Yes, and I'm looking at one right now"

In all honesty, most situations are abstracted for treatment (and survival). Patients become dehumanised, are a bundle of symptoms just waiting to be treated; and if they can talk, you try out a bad joke to test their sense of humour (and you can then reenter the real world again). Most situations are horrible for the people involved - mostly because people panic and common sense (if they ever had any) flies out of the window; or in a minor amount of cases, because someone is quite sick or even dead.

But it is the patients emergency. At the end of the day I don't know them. Their pain is visible to me, I can usually imagine that If it were me in the same situation I would be equally sad/distraught/griefstricken. But I'm not. I walk out of that job and that's that job emotionally done. The only memories are professional ones.

"Thank You"

"Your Welcome". No other reply necessary. Sweet, Sincere and Simple.

"You boys are heroes"

No we're not.

"Arm das Land das Helden noetig hat - Unlucky the nation that needs heroes"
(Galilei, in B. Brechts "Das Leben des Galileo).

tidying

2010-06-01T16:38:00.000+08:00

Recently, I cleaned up the bedside table at the ambulance station. It was full of readers digest and various womens magazines from the past 20 years, mixed with a single epaullette, a lightglobe and a lone raisin.

And a book: "Picking up Girls", by Ira Alterman, published in 1982. Just right for some down time on a night shift.

Browsing the index, the chapter "How to get out of a girls house during a one night stand" caught my eye. Flip to page 55, there are some great words of wisdom:

"Someone, somewhere has left there car lights on. I'm going to find them and turn them off"

"I'm so happy I could run around the block. Here, let me show you!"

- - - End of public service announcement - - -

To all fellow students

2010-05-05T08:33:00.000+08:00

This semester is full on. We have two major units to complete, paediatrics and obstetrics. Both are of the category 'own worst nightmare calls', as a) I can't relate to the jobs (not being female and not being the best around kids), and b) due the the above I don't take as much of an interest in them.

Funny thing that. You don't like those type of job, so you try avoid learning about them as well.

So I actively try to overcome this fear. Trying to plunge myself in to the depths of it all. We recently had a near-birth situation - luckily, we arrived at hospital on time. Good thing we did, because the wee one didn't want to come out on his own, and Doc needed to use the Ventouse (suction cap). Once out, baby was bluey-purple, floppy, and not screaming. If that had have been in the back of the truck, chances are that I would have been screaming instead...

Suction and some vigorous towel rubbing turned kiddo in to a crying pink little bundle of something in less than ten seconds though. 'Nuther lesson learnt.

At the end of the day, young people can easily flip the panic switch in my world. I just cannot relate to them. A fact that won't change anytime soon.

---

I actually meant to write this post about how an extreme workload at university can have a negative impact on your patient care (goes to show I probably needed to vent something else!). I've been very busy lately, and the last couple of days at work have seen a slightly tired and mediocre approach.

Anybody else have similar experiences?

thoughts

2010-04-27T10:52:00.001+08:00

So, there I am, standing on a bed, holding an elderly lady on all fours; all while my colleague stabilises her hips and the son cleans the aftermath of an eruptive diarrhoeal episode.

And I think to myself: what a wonderful job.

Please give a very warm welcome to...

2010-04-18T09:01:00.001+08:00

...the new students that hit the road today! They're a good bunch, enthusiastic and eager to learn.

All the best to all of you, and looking forward to seeing you out there!

(and by the way, it's my 1st anniversary in this job - one whole year of being out on the road! Hooray to me!)

Stories from ED

2010-04-15T15:36:00.001+08:00

Chatting to a nurse in an emergency department the other night. We had just handed over a patient who had left a few crawling insects on our stretcher. Talk topics ranging from various body parts to bodily fluids over to cleaning up:

Nurse: "We recently cleaned out the the kitchen and found a finger in the fridge"

Murphy Time

2010-03-30T12:07:00.000+08:00

If you ever find yourself at the beginning of a shift without a wristwatch on, you are guaranteed that
a) you will immediately get a priority one call, making you forget to attach said watch to wrist
b) be busy for the next eight hours and never get back to the station
c) never know what time it is
d) you always have to ask a patient/bystander/colleague what time it is (for documentation)
e) you will get an obstetrics job without any way of timing contractions
f) you will get an overdose job without any way of timing the respiratory rate.

...wait, methinks.

If you have a patient attached to your (loudly beeping) cardiac monitor with a heart rate of 90, instead of counting breaths for 15 seconds and multiplying by 4 (to get to 60 seconds), all you do is count breath sounds with your left hand, whilst counting monitor beeps in your head.
4 breaths every 18 beeps (12 seconds) equals a respiratory rate of 20.

What would we do without the machine that goes 'bing'?

New ACAP website!

2010-03-28T15:21:00.000+08:00

...since nobody else is going to tell the world (I only found out by chance the other day), here it is:

http://www.acap.org.au/

MegaMiles ahead of the old site (what a dinosaur of the net that was), this one is indeed quite palatable.

Go check it out:

note to self

2010-03-28T02:24:00.000+08:00

If a patient needs spinal precautions (immobilized: laid flat on a scoop stretcher and a cervical collar applied) - consider an antiemetic.

Otherwise, moving an immobilized patient on their side in time for a hefty chunder will result in chunky bits of pineapple and pizza dough all on the side of your ambulance and on you glove.
You may even feel a little nauseated yourself.

A lay in the wife of a perking daramedic

2010-03-25T17:14:00.000+08:00

Nothing to dart the stay like riding to work on a well boiled icycle.
Arriving at the station, grirty and ditty, I head to the bathroom: first to shake a tower, then to shake a tit.
All carkly and speen, I am deady for the ray.

"What will another ray on the doad bring?" I wonder to myself.
"Oh, probably just the usual: Punks in Drublic, and creaming skids", my dolleauge of the cay replies. He is still a ew nambo, and mean as custard.

Preparing for a dong lay, I realise I forgot my lacked punch at home. "We'll have to go via the mood fart and pick something up" I say to myself.

SEEP SEEP SEEP! goes the belcall. Oh no, we jot a gob!

Lets lave a hook…oh no, Michael Clarke has been in a Bingle, and needs rescuing.

Sights and Lirens, we drive at the leed of spite to the scene. Upon arrival, the criver of the dar approaches us, dad as a mog:

"She bit my humper!" he louts like a shunatic. "I was looking for a sparking pace, there was a thoud lump. The other driver came up to me with a prying fan in her hand and gave me a blushing crow".

It was at that time when the fffire tttruck arrived to rock the bload. So I went over to the other driver to get her side of the story.

She was crying, so I started teasing her ears. She appreciated my concern, and thanked me. She even offered for me to come back to her flock of bats to show me her tool kits. I declined.
Turns out she was my rental deceptionist, and just driving around to chew some doors in her brunch lake.

She told me the whole story; it was heartbreaking. A really bad sallad. Turns out his version of the accident was a lack of pies. "The guy is nucking futs" she told me.

Just as I go back to Mr clark, it starts roaring with pain. I despise ret wain, but you cannot fun from your rear in this job, so I put my Jain Racket on. Mr clarke was under arrest for not driving with appropriate footwear, he was barefoot. "Did you leave your booze under the shed?" I enquired, but got no answer, because he was crying. What a shining wit, I thought to myself, a real smart fella.

The girl thanked us again, and although she was upset I tell her that she has soap in her hole. "you must trust in dog, for the lord is a shoving leopard. Time wounds all heels.".

"No wucking forries" she replies, and give me a smig bile.

Back to the stambulance ation we head, for it is letting gate. We exchange some star wories, for example the first car vs pedestrian we attended - turned out she was an overhead door.

The day comes to an end, and it is teepy slime. Unfortunately, I suffer from eep slapnea, which may cause drain bamage in the rong lun, my doctor tells me. That may explain why i occasionally get my merds wixed up.

But I live in hope. As they say: "it ain't over 'til the fat sady lings"

reflecting

2010-03-11T11:37:00.000+08:00

Ever since I can remember, I had an obsession with emergency services.

Where it stems from, I don't know, but flashing lights would always seize my attention and not let go until the absolute last ray of light from the flashing beacons had been devoured by my eyes.

I can pick a siren from miles away. I would always try and steal a glance at any passing emergency vehicle. On holiday in NYC as an eight year old, most of the pictures taken by me were police cars, fire trucks and ambulances.

Still no change. Flashing lights mesmerize me. If I park my ambulance up on the road and need the emergency lights on for warning purposes, I always catch myself gazing up to the lightbar, hypnotized by its flashing pattern. Checking the van before a shift, I love watching the beacons dancing on the walls.

- ~ -

Over time (and as I got older), interest developed from the exterior of the vehicle to the interior of the vehicle; who sits inside and what do they do! Natural progression (with a few detours enroute) guided me in to this job. Job? A calling.

I might moan about so called timewasters at 3am, or lack of sleep, or strange colleagues, or management...but in the end I'm in my dream environment.

- ~ -

I sit in a truck covered in pretty flashing lights. I am allowed to make noises with my siren. I get paid to do so.

That little kid on the side of the road staring with a dropped jaw at the ambulance whizzing by? That kid has (physically) grown up and is writing these very words.

And is extremely happy :-)

Five AM Farkwit

2010-03-05T08:08:00.000+08:00

Long night, get to bed at 0430hrs.

0500hrs comes around, and our colleagues up in the communications centre have a great job lined up for us:

"Patients veins in hand swell up if hand is held below level of heart"

Now, dear read: please do exactly that: let you arm hand lowere than your heart, and you will realise that this is a perfectly natural occurrence. Something that has to do with gravity, apparently.

Not breaking any land speed records, we got cancelled on this call half way there. Which was probably good, because the second bit of information we got was "ambulance attended to patient recently. Patient has vast array of knives at home"

One step forwards for man. One step backwards for mankind.

Re

2010-03-05T07:48:00.001+08:00

Been awhile since I've written something up here. I've been up to a few things, busy at work, unfortunately there has been nothing special to report.

Another 6 weeks and I will have my one year anniversary as an on road Ambulance Officer.
A lot of 're's going on in my head:

reflecting what a ride I've had the past 12 months, from induction school to on road work.
reevaluating where I am and what I am doing.
relearning infrequently used skills and protocols.
researching new and better ways to do things.
really tired - I just slept for twelve hours.
real estate agents...

I think the above list would be perfect for a set of posts, don't you?

insomniARGH!

2010-02-17T00:11:00.000+08:00

Well...I guess it's a part of shift work. You come home, lack of sleep translates in to lack of lust and thrust for all things productive.

Unfortunately, I forgot to set an alarm, in doing so slept much to long. It's just past midnight, and although I am physically tired and mentally drained, sleep is a distant figure in the current picture of things.

No sleep + no volition = long, pointless night.

All work and no play makes Jack a dull boy

2010-02-06T16:40:00.000+08:00

An interfacility transfer, nothing to write home about, clinically at least.

But I always feel awkward sitting in the back of an ambulance with a patient who knows he only has a couple of months left to live.

There isn't anything to say.

So, there you go. Late forties, successful businessman, good amounts of hard earned cash, and an incurable disease.

If I were to drop dead in two minutes time, I could honestly say I am happy with my life.

Could you?

Stop, Swap'n'Roll

2010-02-03T10:38:00.000+08:00

I believe that was what I was told in first aid if I ever find myself to be in the unfortunate situation of being on fire.

A colleague approached a while back, asking if I could do a shift for her, as she had to go to a friends wedding. I agreed, as I needed someone to cover a shift for me for a concert that would have normally fallen on one of my rostered days on. I was also coaxed in to the swap with a "it's a cosy little depot, we usually do two jobs a day."

So there I am, just got the basics of my uniform on, and have just checked our drug bag (haven't got to check to ambulance yet) when a priority one comes in, ten minutes before shift start. We're the only ones around, so it's us. My partner looks at me with that look in her eye: "it's all your fault, normally this never happens". Person fallen from roof, approx 3m height. So off we scoot, take all our gear and save our patient who was cleaning the gutters, but whos roof didn't feel like putting up with the strain. A good job, invovling a lot of monitoring, scene organizing and sweeping broken bits of roof.

We clear from BiggerHospitalFurtherAway, and get sent to a minor job in that area.Nothing of interest, patient is taken to BiggerHospitalFurtherAway. We try and make our way back again. Another little job comes up around the corner, but in our local area; patient taken to LocalHospital. Just as we clear we are assigned to another priority one: patient collapsed on toilet.

"Ah, syncopial episode" my partner waves it off as. "Was on the loo, pushed a bit to hard, increased blood pressure went to his head and made him faint". I'm a little sceptical. Partner is sure it will be a nothing call, and promises me a little jig if the call proves her wrong. I take all my gear with me just in case. And indeed, patient is lying on the floor near the toilet. Patient is also being obstreperous, and will not sit up straight, even less push with his legs in order to get us out of this tight spot we're caught in (people tend to fall in awkward places...). I'm about to get annoyed with said patient, and tell him off why he isn't cooperating, when I remember to ask a little question: "Can you wriggle your toes for me sir?" Patient wriggles toes on one foot only. "Can you wiggle your fingers for me please, sir?" Patient wiggles fingers only on one hand. Adds up with patient unable to sit up straight...patient has more than likely had a stroke. Luckily, there are friends and family around to help with extrication, and we end up 'one-ing' our patient in to hospital (lights and a little siren use). Another god job. And a little jig performed just for me, unfortunately cameras not allowed...

Time for some food, and whilst standing in the queue at the local american restaurant, a teenage girl turns around, spots me a exclaims loudly and excitedly to her friends: "Look, it's an ambulance dude!". Yes, dear, it is an ambulance dude. Hungry ambulance dude actually.

We nibble our food in the ambulance, and don't make it back to the station. Someone with breathing difficulties has called us. Patient is a regular, his emphysema plays up on him every now and again. My partner has seen him a couple of times, an easy call. Well, I've already earned my title 'shit magnet' today, so I don't take anything easy, and grab all the gear just in case. But patient is not in too bad of a shape, and walks to ambulance.

We finally get back to the depot for 10 minutes, then get called out again for a transfer from hospital back to a nursing home. Done, easy, and of course another job pops up on our screen: "person feeling dizzy", a non urgent call. It's been a long day, and we only have another hour left to go before our shift finishes; fatigue is slowly replacing enthusiasm.

Sounds simple enough, and we are around the corner. In we go - greeted with histeria, screaming and tears. All coming from the wife, who probably has apocalyptic feelings rushing through her head right this very moment: Her husband is in the middle of having a tonic seizure. Rigid as a plank of wood, every visible muscle in his body tense, spitting phlegm, breathing like a raging bull.

And there I stand, lonely me, clinging on to my little drug bag like it was my rucksack on my first day of school.

My Colleague though, cool as a cucumber, hovers over to the wife and hands her a pen and a piece of paper: "It's really important that you fill out your husbands details so we can help him. Thanks!".

My freeze moment only lasted two seconds, I am getting some drugs ready in case they are needed, plus I am regretting not taking any other equipment in for this job. Luckily, cool cucumber colleague has done her paperwork bit and is getting all the stuff I ask her for.

The rest of the job is easy: Pt stops seizing, patients wife calms down, take patient to hospital, patient still can't remember what happened, but is grateful we are there to help him.

Phew. What a day.

Overheard in Hospital

2010-02-02T19:49:00.001+08:00

Nurse: "We're going to slide you from this trolley on to that bed now, OK?"

Patient (in pain): "No (cringe), wait (pant)! I think my arsehole's fallen off."

redecorating

2010-01-23T22:30:00.000+08:00

Entering the Apocalypse.
There he is, lying on his side, passed out on a friends bed. The mattress is soaked with all imaginable body fluids: sweat, vomit, urine, blood, and possibly even more.

If that's not enough, he has managed to projectile vomit right up in to the upper most corner of the room, a good 2.5 metres from where he is lying.

Whilst his friends carry him out to the stretcher, he gets a bit of a wriggle attack; they manage to just miss the bottle of Bourbon on the bookshelf, the neighbouring picture frame is not as lucky.

On the way out he has a silly attempt of coughing, vomiting and spitting at the same time, lightly covering my colleague in delicious mucous.

During the whole time, home, transport and hospital, he has a nasty smirk on his face. I wish he would realise that he is using up precious resources: an emergency ambulance, the emergency department, and our wasted sleep.

I wish him an extremely awful hangover and some friends that will whack some sense in to him.

Allergies

2010-01-16T21:14:00.002+08:00

Time: Afternoon
Place: Back of an Ambulance
Person: Yours truly looking after an elderly gentleman

"Do you have any allergies, sir?"

"Yes, but she's at home."

I want my...

2010-01-15T10:22:00.000+08:00

Big brute, tough guy. Shaved head, beard, tattoos; the person you don't want to encounter on your own in a dark alley.

"Who should I put down as your next of kin, sir? Your (grown up) son?"

"My mummy."

Protégé

2010-01-13T10:39:00.000+08:00

As a part of our uni course, the first years (pre employment/full time uni students) are get mentors from the second year student pool - so all Qs can be answered, a little guidance can be given etc etc. A good idea, unfortunately not everybody has been making the most of this teaming up...well, you can't force people.

Luckily I got a Protégé who is pretty keen, has an open mind and is thankful for any tips, tricks and exposure. He starts practical training next week, and is due to hit the road in three months, so he came along with us as an observer on a day shift to check out what life is like on a metropolitan ambulance. We had a relatively easy shift, nothing out of the ordinary...but anything from nana transfers to minor road accidents with no injuries he lapped up with unstoppable enthusiasm.

It was refreshing to have a student with me in a position that I was in 12 months ago. I see a lot of myself in him, the anticipation of not knowing when the next job will come in, what it will be. The thrill of the wailing sires, driving on the wrong side of the road, the eagerness to help us. Talking to patients, checking vital signs. A real pleasure (and help) to have him out with us.

'Twas also a great comparison of my advances over the last 12 months. I realise that I have picked up a lot of information, hints, tips'n'tricks along the way (that I love passing on!). Sure, I don't get massively excited about so called 'run of the mill' calls anymore, but: I still love coming to work every day, I am full of anticipation on nearly every single call that I go to (those three o'clock callouts can be an exception...), and no matter who I deal with, I am always polite and friendly to them. I try to get some further education going on, read articles, blogs, magazines to keep up with the times, talk to other paramedics.

But - I realise I still have a long way to go. Some jobs still chuck sand in my gearbox, grinding me from step to step, or making me forget some simple steps alltogether. I have a high expectation of myself, and want to be good at my job. Every job that I do give me a tad more experience. It is a slow process, and slowly but surely I pick up things along the way...and all of a sudden I take a step back, take a look back and realise I've come one step further.

A never ending trip forwards. And enjoying every step of it.

Big(ish) One

2010-01-05T12:32:00.000+08:00

It's absolutely scorching hot at the moment. The temperature during sunlight hours does not drop below thirty degrees celsius; generally around midday it reaches anywhere between 35 ad 40.

Boy am I glad that I'm on nights tonight.

- ~ -

So, there we were yesterday, heading back to station when we get a job sent down. Appears to be a resus at a beach - and I'm attending, plus we're the closest crew.

I discuss our plan of attack with my partner. This is my first resus where we are first on scene. It's also my first beach job. And just the previous day I was telling my girlfriend I haven't had a job that gets me all excited and nervous in a while. I'm definitely excited and nervous and ready to pounce - adrenaline a pumpin'.

Grab gear, dash off, and there is a good walk to the water. Let me remind you of the 39 degree heat in the shade. There is no shade on the beach.

Two kids have been washed out at sea, and were pulled in by lifeguards. My patients. 100 metres away another person has been pulled out of the ocean, my partners patient.

My kids are breathing and on oxygen (you lifeguards are a bloody brilliant bunch), on their side, plus their heads being stabilised. Thing is, with people being dumped by the waves in the ocean, they might have neck injuries, so we have to go the full monty with spinal precautions until proven otherwise.

ABC, ABC, ABC. All I can think of doing. Airway, Breathing Circulation. Kids are whimpering, chests heaving, pulse palpable. Not much more I can do without backup. Minutes pass, then a Team Leader and another ambulance arrive, followed by another ambulance. I can hand one child over to the second crew, and together with the lifeguards we pop my patient on a board, then on to the back of a beach buggy and I get to walk next to it stabilizing the kids neck. Up to the parking lot, hand over out patient to another crew who eventually takes the kiddie to kiddie hospital.

Time to find my crewmate...he's in the back of our van, attending to another patient, a guy who tried to save the kids and got washed away himself. Ended up taking him to hospital, and finding out that all patients apparently got out of the whole situation with nothing more than a shock, some bad memories and hopefully a lasting message to SWIM BETWEEN THE FLAGS.

What did I get out of it? A good chunk of experience, enough Vitamin D to last me the rest of the year and an ambulance so full of sand that I could have built a 1:1 replica of the the Neuschwanstein Castle. Thats why you try to attend on jobs like that - it's the drivers responsibility to keep the van clean :-)

So excuse me Taz if I didn't see you, I was caught up in my own little world...

Book Review: Lysa Walder - 999

2009-12-22T15:03:00.001+08:00

Beginning of last month I was fortunate enough to get an observer shift with the London Ambulance Service. And fortune didn't stop there, it pointed me in the direction of the Rapid Response Vehicle of Lysa Walder.

Lysa is not only a paramedic with extended skills (ECP - Emergency Care Practitioner), no, she is also an author. Read on...

- ~ -

Structure & Style

The book is an amalgamation of short stories, each chapter its own little focus on a job that Lysa has gone through. This allows you to read a story here and there and bit by bit. Or, you could just keep on reading and let the stories engulf you until the last page appears. I chose the second option.

I found the writing style to be informative not only in a way of "let me tell you a story", but also along the lines of "this is job, this is how I do it, give it a go!"

Content

The book has some great little nuggets of life on its pages. The stories range from quirky to sad, from smelly to mad.

The book is divided up into multiple themes, so you always pick it up and read something appropriate to your mood, be it hilarious, strange or just plain wrong.

What struck me was the lack of negativity. Us ambo folks can be a real good bunch of whingers: not enough money, not enough skills, the ambulances are too small, the patients are annoying, my right toe has an itchy twitch....none of that to be found here. Which is a refreshing change.

There is not much clinical knowledge to be learnt from this book, but that is not what it had been written for.

Yes, the emotional side of the book is fairly prominent, but that is not a bad thing. It is a direct reflection of the job - having to be scooped up by an ambulance crew is never without it's own little private hell endured by the patient.

Verdict

In one word: Positive.

In a couple more words: A slice of life out on the road, neatly presented, written well with a glowing positive attitude. One gripe though: it could be a little longer.

What I can say from a professional point of view, is that I would have loved to have this book 9 months ago before I actually hit the road.

All in all? I'd say: Buy it. Get a copy. You want to know what our work is like? Take a parrot peek from Lysas shoulder. Considering joining the profession? Come on an observer shift in your mind. Newbie at the job? Grab a piece of the experience pie that Lysa has on offer. Already in the job? Have a read what Life is Like in London. Already working for the LAS? Support good book from a great colleague (on amazon here. Aussie Buyers HERE)

'Nuff said.

Collection

2009-12-22T13:38:00.000+08:00

I am putting together a folder for next years newbies who will hit the road in about four months. I am looking to include all the information I wished I had when I hit the road, but had to find and fight for myself. Here is a brief idea and overview for its contents:

General Medical/Treatment Tips
Maps of Hospitals
Capabilities of Hospitals (Trauma/Neurological centres)

I'm still currently in draft stage, and would appreciate any input from you guys out there. What did YOU want to know, but were too afraid to ask when you hit the road?

Cheers in advance :-)

APA

2009-12-22T13:28:00.001+08:00

...or Alternative Paediatric Analgesia.
Following up on my earlier post, a couple of days we were called to a Kiddie who had got his finger stuck in a door. Screaming his head of when we arrived, he calmed down a little once I got down to his level and introduced myself and told him we're going to make his finger better. Distraction part one, we're getting there.
My colleague then begins to bandage his finger, after taping it up she draws a big smileyface on the tape hlding it together. "Show me your teeth!" Kid give us a big gappy grin, my collegue draws little teeth on the smiley.
"Stick you tongue out at me!" Kid is laughing by now, pokes his tongue out at us. Smileyface gets a big tongue drawn.

We're ready to go to hospital. En route our patients finger is only "a little sore", but he is in good spirits. To keep it that way, I make him a toy elephant out of a rubber glove, and let him draw eyes, mouth and hair. Kid makes trumpety noises and plays "charging elephant on an african savannah" in the back of our van. But the fun doesn't stop there: Hairy the elephant (I encouraged Kiddo to give the elephant a name) and Kiddo get dressed up in swine flu masks and safety glasses, dad takes a picture for old times sake.

By the time we're at hospital Kiddo is happy, has a new toy and a story to tell at school next year. And I didn't have to give any chemical pain relief :-)

Misunderstood?

2009-12-19T10:00:00.001+08:00

Standing in a pub at my girlfriends Christmas Party, a waitress approaches our group and offers me some sausage, dripping with oil, wrapped in bacon, dripping in fat. I am torn between health and hunger, but the latter wins.

"Yum. May as well die a slow and painful death" I say.

"Thank you." she replies.

I should have stuck a wooden pole through her heart.

Pity the fooled!

2009-12-18T18:56:00.000+08:00

A recent shift. We started off with a full drug bag, and managed to nearly deplete all our pain relief.
Did everybody really need the pain relief? Pain is something very personal - so if someone seems like they are in pain, they will get some pain relief.
Did everybody really deserve the pain relief? Not my call to make. I'm not experienced enough to say for sure if someone is faking their pain, and I would rather give out a little more than not enough.

I will be interested to see my take on this issue in a couple of years time with more experience under my belt.

Still a little hazy...

2009-12-05T06:53:00.000+08:00

We pull up with the ambulance outside the hospital, ready for a transfer out. Still not quite there yet, it's my second shift back from holidays.

I stare blankly at my colleague in the passenger seat beside me. I then turn to the windscreen and give it a good, long, hard, blank stare. I am thinking. What do I do now?

Ah, that's right, get the stretcher. What a jolly good idea!

The day could continue...

Rettungsdienst Frankfurt

2009-11-29T10:53:00.000+08:00

I started my career in Germany as a volunteer ambo. So, going back there it was a given that I'd pop in to say hi to a few colleagues - and then I even managed to get a nightshift with them!

Unfortunately the pics didn't turn out well, but above are a few so you can get an idea of the workspace of Paramedics in Frankfurt.

Things work quite differently over there. For one, they have emergency doctors in response cars. Paramedics aren't allowed to do as much as in Australia, UK, US etc. I am preparing a couple of more blog posts to follow, comparing the (West) Australian Ambulance Service to the service in London and Frankfurt.

Until then, I have a night shift to go to tonight. After two weeks in continental Europe, I may have forgotten on what side of the road we drive on over here, but not to worry: I can always switch on the flashing lights in case I get confused...

London in Pictures

2009-11-28T10:30:00.000+08:00

London is colourful. "Wait!", you say, "surely not now, it's November!"

a) look at the cool bikes strewn all over the city:

b) look at the enormous amount of bright yellow ambulances decorating the city. And if you had a good look recently, you may have spotted yours truly

having a ball next to the amazing Lysa Walder

who is an

with the

Detailed report coming shortly...

Back!

2009-11-27T13:57:00.000+08:00

Back from Holidays.

Back from Europe.

Back to Life

Back to Reality.

What a Pity.

- ~ -

Three weeks including London, Paris, Frankfurt, Munich, Hamburg, Stuttgart, Heidelberg & Ruedesheim. Plus two ambulance shifts and constantly on the lookout for anything with flashing lights - it's hard to kick the habit.

Stay tunes for detailed reports.

bright and light

2009-10-29T19:30:00.000+08:00

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

2009-10-27T09:13:00.001+08:00

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!

2009-10-26T09:03:00.000+08:00

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

2009-10-23T12:09:00.000+08:00

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

2009-10-22T14:19:00.000+08:00

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!

2009-10-19T12:28:00.001+08:00

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

expectations: met

2009-10-12T13:31:00.000+08:00

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

2009-10-10T11:14:00.000+08:00

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

2009-10-07T11:36:00.000+08:00

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?

2009-10-03T12:39:00.000+08:00

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

2009-10-02T21:45:00.000+08:00

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!

Not straightforward

2009-09-30T11:17:00.000+08:00

A while back we attended to a lady late at night who was complaining of abdominal pain. She had had an accident earlier in the day, but had adamantly refused treatment and transport by the attending crew.

We arrive at scene, and find an emotional woman sitting in a chair on the front patio. She stands up, tells us about the accident, and describes where the pain is - upper hip bone area, right where the lap section of the seatbelt goes across.

And then she pulls down her pants to show us the bruising.

Hmm...not what I had expected, but we both look away and ask her if she could please pull her trousers back up, the sooner the better. She doesn't know if she should go to hospital or not, but we encourage her to get checked out.

At hospital, they breathalyze her for a blood alcohol concentration (BAC) reading - which, you guessed it, comes back as well above the legal limit. Upon being asked about drinking, she replies she had a couple to drink after she got home from the accident. Fair enough; but is that the truth? Was she in fact under the influence of alcohol during the accident? The police did not attend (why I do not know, apparently it happened at a busy intersection), and she refused transport. Possibly she wanted to avoid the authorities.

Conspiracy or not, it opened my eyes to the possibilities, and to get the cops involved if there is any doubt at all. Drink Driving is not something that should be taken lightly. Go harm yourself if you absolutely must (although I would recommend seeking psychiatric help instead), but leave others out of it.

A matter of laugh or death

2009-09-30T08:56:00.000+08:00

I swapped a shift the other so I could get a day off in a couple of weeks, in order to go to a wedding. This allowed me to work with a friend and excellent paramedic on the ambulance once again - the fellow who taught me the ropes, who I was teamed up with for the first two months of my on road experience.

And it was excellent.

No whinging about calls, no silence in the cab, always chatting to each other, to patients, to members of the public. A very smooth operator. And great in tricky and time critical situations too. What more would you want?

We had a good shift: Started off slow, which allowed us time for some food, a chat to the staff and a drive around our local area (which I was unfamiliar to). A chest pain then came up on our screen, and on came the lights, down went the accelerator. Chest pains are a fairly standard call for us, this one was a bit difficult due to poor details of patient history (our patient had learning disabilities). But nonetheless a job we mastered - especially since I was shown how to do modified chest leads (9 lead ECG) with our 3 leads monitor. Another skill that is excellent.

A transfer next which stretched my partners communication skills to the max...40 minutes and hundreds of bad jokes, singing competitions, stories of the homeland, anecdotes about past jobs and generally made up fairy tales later we arrived at our destination, with a patient with a bleeding ear and a partner with a bleeding mouth :-)

Next up, we got a call where I don't want to go in to any detail at all, due to the fact that the police are heavily involved, and matters may go to court. No space for stuff like this in a public forum, sorry guys (I know you are reading this now with an intense dislike of yours truly growing bigger by the second..."why does this bastard have to tell us that he won't tell us?" Hahaha, curiosity getting to y'all?)
What I will tell you is that it tied up nicely with one of my current uni subjects. Maybe more to come about that job further down the track.

That job only took about 3 1/2 hours all in all, including police statements, standing in the pouring rain, a bit of medical treatment and trying to kill some time in the early hours of the morning. So we grabbed a sausage roll and some choc milk, had a debrief about what happened, and headed back to station for a kip.

Rounding up the day was another transfer with a sedated patient but a chatty nurse, easy enough. I had to head to uni after shift, so on the way back to the depot from hospital I popped myself in the stretcher, buckled up and caught up on some sleep.

Sweet dreams!

limb-o

2009-09-28T09:00:00.067+08:00

Saturday night, and I am geared up for a big night. I want a big night. I need a big night. No tough jobs to sink my teeth in to means no experience for me. Throw it at me, give me the big stuff while I'm keen and enthusiastic. Please.

Pretty Please?

Nothing too exciting again, but I can tick the burns bit off the 'to do' list. Our jobs were as following:

Hip pain. Pretty bad hip pain actually, this was genuine 9 out of 10 pain on movement, zero on lying still. In went the drugs, and out went the patient...still in a considerate amount of pain, but coping. As soon as we had him on our stretcher, the only remnant of the pain was a dull ache, and that stopped soon after, namely when he fell asleep en route. Drugs worked a treat.
Abdominal Pain, together with Nausea and Diarrhoea. Got the patient talking and comfortable, and had a smooth trip to hospital.
Legs. We should have an additional set in the van for patients. We have a lot of patients with buggered legs. Why don't we carry replacement legs? Our next patient, for example, could have done with another set, together with another heart I s'pose. Patients legs were just absolutely, most definitely, quite over the top full of fluid (right sided heart failure, or congestive heart/cardiac failure aka CHF/CCF). The legs had ulcers on them too. So, what does big pressure, big water and big sores mean? Leaky Legs, correct! There were water droplets, like sweat, all over the legs. Mild SOB to go with it, but the legs were impressive (close to this prize shot I found on the web). A short explanation scribbled by somebody on her notes gave us a good chuckle: "Patients legs have swallowed today". Ah, no wonder they were so big, they had swallowed a 1.5 litre coke bottle *smirk smirk*.
More Legs, this time the elements were in role reversal...from water to fire. A Stove had made unpleasant contact with the back of our next patients leg, burning it deeply. In correct drunken manner, a friend had applied betadine - an antiseptic cream. And hadn't cooled the burn. Ouch. Problem is, cream will trap the heat, and worsen the burn. So off we flushed it with Saline, cooled it with wet bandages, and then applied tea tree oil compresses - Burn Aid dressings (messy, but smell lovely!). Our patient stated he was in 10 out of 10 pain...so I considered, and even drew up our strongest pain relief medication. Only to see our patient had fallen asleep. So much for intense pain :-) I continued with our other pain relief instead, and made sure the burn was kept covered and cool.
Last but not least to finish our limb-o: RFDS transfer for a patient who had taken a tumble and broken his wrist. It was 3am, so patient caught up on some sleep, while I filled out the paperwork and enjoyed the views outside.

Smiles and Spikes

2009-09-27T12:54:00.000+08:00

As the title suggests, it was an easy going day with a slightly interesting case thrown in. We had

the 93 year old lady (who looked like 63 and who's mind was even younger) who was feeling unwell, probably due to a mild reaction to some prescription medicine - one of the three medications she was one. And that at 93. Go Girl!
an elderly patient collapse, again probably due to some reaction to his medication. He would not stop talking en route, all talk and smiles. Makes monitoring conscious levels easy :-)
a transfer - slightly nutty old chap, but genuinely friendly. Started a great 'grumpy ld men' performance once he was back in his nursing home room with his long time roommate. Good laugh.
an interesting trauma job: Our patient had tripped and fell out on a field. In the process of falling, as you do, she stuck her hands out to break the fall...unfortunately her hands aimed right to the spot on the ground where a couple of rusty metal spikes happened to be. Said spike then penetrated the top of her hand at wrist level, and came out the other end of the top of the hand, where the fingers are. Ouch. My first penetrating wound, but really not much we could do apart from re-bandage. I was very proud though: I remembered I had my camera with my, and took some pictures for the hospital, one of the wound and one of the metal spike. The nurse seemed appreciative of the added insight.

All in all nothing challenging. I'm sure those jobs will come, they are just unfortunately taking their time.

Busy Friday and lazy Sunday

2009-09-21T18:49:00.000+08:00

Nothing much out of the ordinary though. Friday produced ten jobs callouts for us. Here they are:

Female, late 60's, left sided arm pain, relieved with GTN, recently discharged from hospital...and promptly recharged to hospital (well...admitted is probably the more correct term....but if you can be discharged, don't you get recharged at some point in time?).
Stood down, call cancelled. I had an inkling this would happen...the ocation was 20km away, and was a report from someone driving by of a person lying on the ground. Thanks to the police, we got to go back to our beloved depot.
Priority one inter facility transfer - from one hospital to another. Interesting case this one actually, our patient had had a minor accident a couple of hours previously. To cut a long story short, the patient was not acting strange after the accident because of the accident, she actually had the accident because of having a body wide infection, with a couple of other things going on. Eventless transport, but some good insight thanks to the nice doc and nurse escort. Also an eye opener: you never know what could have caused an accident or funny behaviour!
Kid who had grabbed mums sleeping tablets. Two of them to be precise. Two and a half hours prior to our dispatch. I didn't really clue in why we got sent light and sirens, but I was happy that kiddiewinks was alright. We transported mum and kid to hospital for a checkup. En route, child showed me he had a little bit of tummyache, so I gave him one of our great little vomit bags. He then proceeded to open it up, stick his head in to the bag, and make loud farting noises. Yep, this kid is healthy, and this is a taxi job :-)
Male, Post assault in pub. No ordinary party at the pub though. It was flintstones night! I was met by Fred, one of the security fellows, who walked me though the club and introduced me to Barny, our patient. Wilma was on scene too, applying some TLC. And Betty was quite upset about her boyfriend. And the whole situation was quiet comical - literally.
Picked up a job on our way back to a fitting octogenarian. Poor fellow didn't know what had happened, but he was compliant and came to hospital with us. His wife was pretty upset about the whole situation, and calming her down was not easy, as she didn't speak english.
RFDS transfer for a non STEMI patient.
Stood down, picked up a Priority One.
Female complaining of migraine. But with associated health issues - so warranted an ambulance if you ask me.

If you were to see my case sheets, you would see a direct correlation between progressing of nighttime, the readability of my handwriting and the amount of information on the sheet. Working at 4am brings out the minimalist in you, treatment wise.

I did an additional Sunday nightshift for a mate who did a dayshift for me the other week. Actually, it was bastard mate who tried to tell me he did two resuscitations in a row.
Well, his dream job is to have a really off-yer-knob psychiatric patient. So I told him just that: We had a really psycho crazy mofo who we had to inject with Midazolam and Haloperidol, or else the police would have had to Tazer him. We also tied him down to the stretcher, and placed the scoop stretcher on top of him (tied down again), as a sort of makeshift cage, in case he arched up again. Wow, what a job, crazy.
Well, of course non of this happened, but revenge is sweet. In reality, it was a very cruisy night:

Stood down for a Priority 1
80+ female post collapse, heart and abdo problems, all around not too healthy. Off to hospital.
Transfer hospital to mens hostel. Nice fellow, great carers!
80+ female, who tripped whilst going to the telephone. Probably won't be coming back home, she had broken some bones and was aware of the implications it had. I felt sorry, held her hand, but couldn't speak her language. Sad.
Stood down, the police took care of our person lying on the pavement.

The shift was good. I worked with another paramedic who I really get on with well. Throughout our jobs, we had monty python blaring on the radio, and we were singing along to such hits as "always look on the bright side of life", "eric the half-a-bee" and "never be rude to an arab". Brilliant.

feature

2009-09-20T11:19:00.000+08:00

Ooh, look mummy, I've been featured in the new list of blogs up at EMS1.com!

Check it out here, and go pop by the other blogs too - they're well worth it.

Impersonator

2009-09-18T16:12:00.000+08:00

Female, post assault, now short of breath, sweaty, complaining of chest pains.

It's late-night shopping in the 'burbs, Usually at this time of night we can get away with our lights only, but the traffic is flowing yet pretty thick. The siren bounces off the walls of the neighbouring houses, mushing a clean wail in to a warbled song from a dying duck who has just hit puberty.

A couple of minutes later we walk in through the doors of our patients house. Our first impression is to take the pressure down, everything is going good so far. Turns out there was a fight between mum and daughter, and we have a more emotional rather than physical situation to deal with. Attendant attends to patient, I gather some background info for our paperwork. Apparently the daughter is still in the house.

"Hello?"

I turn around. This was a child's voice, a little girl. Was that the offender? Nobody to be seen.

"Hello?"

A child's voice, young female, a little scratchy, possibly even a little....

"Hello?"

...squawky. Damn bird!

I had not consciously taken in the massive bird cage next to the front door. Cocky the cockatoo (well, a galah to be precise) was toying with my brain, and only trying to be polite. I walk up to the cage to reciprocate the greeting.

"Hello little bird!" I say.

"MEOW" it replies.

This bird has lost its conkers. Absolutely out of its mind, stark raving mad. Then again, if you are a caged bird surrounded by 6 cats, you would pick up a bit of foreign language here and there. As we leave, the bird looks at us and tells us to "nick off". No manners whatsoever.

- ~ -

The other jobs of the night weren't anything special, but here is a quick summary:

Fellow released from hospital just hours before, still complaining of neck pain. Back to hospital again for reevaluation and pain management.
Kid with Asthma, Kid was fine.
Old feller with a blocked catheter/haematuria (blood in urine). Nice chap.
RFDS transfer with a sedated, intubated and ventilated patient.

Last monday

2009-09-17T09:26:00.000+08:00

Been pretty slow at work recently. Some days things go wrong, some days things work out, and some days people just don't hurt themselves. Just like in real life.

I can't remember all the jobs, one of them did stick with me though: We were called to a teenager, not picking up the phone at home, ?OD. Call from mum.
So off we race, expecting anything from a huffy teenager refusing to answer the phone because she's angry at mum, to an unconscious patient not breathing. We pull up at the address, and mum pulls up at the same time, so nobody really knows what they're in for.

Luckily our patient was in more of an emotional than a physical emergency. She grabbed some pills by random and took them, also displaying some superficial cuts to her wrists. This was not a suicide attempt, it was more of a 'my boyfriend broke up with me and everything else in my life isn't going to plan either' get out of this situation attempt. Pathetic? Timewaster? Some may say, but haven't we all felt pretty down at some time in our lives, especially as a teen? I have, I just never had the will (or the guts?) to do something about it.
I had a good chat to her at hospital, asking her what she wants to do after school, about travelling and so forth, and that cleared up her teary eyes and even got a smile on her face. Job done, patient happy (for a short bit anyway), and I can keep on going with a fuzzy feeling and another smile added to my memory.

Surfing the waves of confidence

2009-09-14T21:43:00.000+08:00

They sure are waves. Up and down they go. You get a few jobs that go well, and you work self in to a high. Everything around you flies by, all is rosy, you are superman with superpowers, and your patients get better.

Chest pains for example. Mavis has a bit of chest tightness. Sure, can happen at the age of eighty-one. I'm dancing around the scene, flicking tablets in her mouth, squirting aspirin in her throat, The ECG is a diddle to interpret and all the right questions come rolling from my tongue like hot butter would go through a knife :-)

Then, you hit a few jobs on the wrong angle, and you stumble, maybe even tumble. Things don't run so smoothly anymore. You have to think hard about every step you do. You forget things. You work slowly. Some blindingly obvious things pass by your five senses.

Like the other night. Female, gulping for breath, in a nursing home. I see the patient in her bed, not looking too healthy actually. I feel for a carotid (neck) pulse, fearing the worst. It is there, but it is ever so faint. I turn in to grind-click-sand in gearbox mode. Oxygen? Yes, brilliant Idea. Oxygen tubing getting tied in a knot? Bloody hell, this patient needs oxygen. Frantically untying tube. Sticky plastic does not aid this process. Not happy.

My colleague is watching me. And calmly asks me if our patient is breathing.
Hmm, maybe she isn't. Maybe she hasn't been for a while. Maybe I shouldn't bother with the oxygen, maybe she doesn't need it.
We do our checks, and we fill out a 'life extinct' form.

I feel pretty down.

catchup post, thursday night

2009-09-12T18:54:00.001+08:00

Male, not communicating. Really, he wasn't talking, moving - nothing. Physically healthy, but had a history of mental health problems. His mother was distressed, understandably. Not much we could do at scene, so transport to hospital for further psychiatric evaluation. Weird, strange, I felt like a sausage talking to him at home. But I gave him all I could, and I hope he could hear and understand me, and I hope I came across in a good manner.
Hyperglycaemic patient (high blood sugar). Again, physically fine, but felt thirsty. This is a good sign of high sugar - it makes you sweat, which makes you thirsty, which makes you drink a lot, which makes you wee a lot. Also, the sugar is high in you blood, but not in the rest of your body (it can't reach there). So you eat a lot. In medical terms: Polydipsia, Polyurea & Polyphagia. Another cool bit of info: Back in ancient greece doctors could tell the difference between diabetes insipidus and diabetes mellitus by...tasting the patients urine. You see, all diabetes is, is a pateint excreting a lot of urine. Insipidus is due to the body having hormonal problems, which lead to increased urine excretion - you are born with this. Mellitus is the body either being resistant to insulin (type II - 99% of the time older onset) or not producing insulin itself (type I - an autoimmune disease, the body destroys its own pancreatic cells, you have this from birth). Anyway, I digress. We took our patient to hospital.
RFDS transfer, liver problems.
Patient deceased in Nursing Home (see seperate post above).
Priority 1 to a cold. Patient very panicky. I managed to calm her down a little, but in the back of my mind the question lingered "you called 000 for a cold? Anyway, I hope my patient treatment did not suffer due to the fact that she had a cold and was panicky. It probably did suffer from lack of sleep though, this job was at 5 am.
This time no priority 1 dispatch, but still a cold. Patient walked sheepishly to ambulance, as he didn't call us, his overly concerned neighbours did. Again, why they didn't take him to hospital himself if they were so concerened remains a mystery. I still treated him as a person, not timewaster.

No sleep that night. Really tired. Slept like a log that day.

catchup post, dayshift just gone by

2009-09-12T18:13:00.000+08:00

Resus! A bittersweet one: Yes he lives, but it was a suicide attempt. So no real happy ending. I'd love to go in to more detail, but I'd rather not, otherwise I might end up in a not so sweet spot.
Female, Vomiting since midnight. Had been feeling unwell for 12 hours. History of same 10 years ago, diagnosis food poisoning. And even 10 years ago they called an ambulance to get our patient to hospital. Some people just don't learn. Patients son was very concerned about mum, and tried to help us as much as possible (read: got in the way). Why he didn't do his mum a favour and take her to hospital himself remains a mystery. Hgrmph.
Polypharmaceutical OD (taken too many too different drugs). Patient started off allright, albeit drowsy. Then things went downhill, and we ended up iwth a completely unresponsive patient. Sights and Lirens to hospital. Good Job.
Easiest job ever: backup for a lift. Arrived at scene, helped the crew lift heavy patient from chair to stretcher, and left again.

A good day.

catchup post, nightshift a week ago

2009-09-12T18:03:00.000+08:00

The shifts were busy. Busy sleeping in between shifts, and then busy camping in my days off -> hence the lack of posts.
More for personal use (so I can look back and remember all my fun little jobs), here is work from a week ago:

Male, cut to head, post fall. Turns out he has been regularly taking 3 instead of 2 sleeping tablets. Also, you are supposed to take these when you are already in bed, avoiding all outside stimuli. Well, this feller didn't, and went a bit crazy. Easy enough of a job, just an eye opener what sleeping tablets can do to you.
Bicycle vs lamppost, guess who won? ETOH ++ (drunk). Worlds biggest, and worst, pain impersonator. Your claim to pain is not 10/10. I may be still young, keen and a little naive, but you aint foolin' me. Go to acting school, and try again.
Female, SOB. More emotional and walking induced than anything else (familky funeral, and she was ~80 yrs old). Lovely old Lady though. Ramped at hospital for 2 hours :-(
RFDS transfer, Female poly drug overdose (OD)
Head on car collision, female self extricated, but complaining of strong abdominal pain. Car pulled out in front of her, seems like she didn't stand a chance. Lucky for her she was in a relatively modern car with airbags and some good safety standards. 10-15 years ago this prang would have had quite a different outcome...

Run from the Fun!

2009-09-12T11:50:00.002+08:00

Imagine yourself wafted away in to the depths of medieval times, 1485 to be precise.

Prince Edmund: They're coming! Run for the hills!

Baldrick: No, my lord! They're coming from the hills!

Prince Edmund: Run away from the hills! Run away from the hills! If you see the hills, go the other way!

- ~ -

Now come back to September 2009, if you wish. It is a Friday night, and poor old diddums here wants some funky action happening in da van (no, not that kind of action, I'm at work, silly).

Priority ones are being sent out to crews north of us, a dime a dozen, and we are on a low priority job. Then again, the familiar silencer, a long beeeeep, gets sent through the radio, telling the crews that a high priority job has just come in, but has not yet been assigned. "This is us, I can feel it" I tell my crewmate...I sense that he is also on the edge of his seat, hoping to get a more exiting job. This job has the potential, I know it.

BINGO!

It's us, we're closest. We light the night with our darkness piercing strobes and oscillating rotators, and part the traffic with the deafening screech of our siren. The engine roars as my crewmate, who is driving tonight, accelerates with full throttle. Water is everywhere, it's pouring from the heavens above, it's below us, our tyres splashing left and right whilst we crash through huge puddles.

But hold on, this job is a relatively standard one. Chest pain, although our patient is only in her late 30's. Better than a transfer, and you just never know.

The radio comes to life again. There has been an accident on the freeway, a crew is sent out on a one. Hmm, methinks, I wouldn't mind doing something like that. Then another crash on the freeway, another crew is sent out to investigate. Hmm, methinks again. I want to do freeway prangs. One of those jobs turns out to be big, read about it here. And I get stuck travelling the other direction to a relatively 'standard' job. Enter Blackadder from above. Ah well, the patient had genuine chest pain (cardiac or not I do not know), I did my bit, patient felt better en route, and I managed to insert a few bad jokes on the way, so I kept myself amused as well :-)

The other jobs were nothing out of the ordinary, they were:

Mental health transfer. Patient was quiet, and the nurse was also a cycling enthusiast, great talking to him.
Regular caller. I had been there before. Patient always claims problems with his heart, and depending on the experience and insight of the calltaker it is either prioritised as chest pain, getting a lights and sirens approach, or as a low priority. This time it was a low priority, so we could finish our dinner. En route I joked to my paramedic that my ECG might even still be hanging on his wall - I printed one off roughly four months ago and stuck it on the wall for other crews to see. And indeed, it was still hanging there. Together with another five print outs. So I added to the collection, patient refused transport, and off we went.
Some job, got stood down for next job
Chest pain, read above
Post assault, brothers fighting. More emotional...well more alcohol than anything else really. Left in care of dad.
0430 in the morning, we drive for 17 minutes to a woman who has severe back pain and cannot get out of bed. Why she wanted to get out of bed at such an ungodly hour eluded me. I shall never find out, because we got stood down and so we headed back in to the depot for some more well needed sleep.

That was my third night shift in a row; I swapped shifts with a fellow student colleague of mine. Right now I am awake, going allright - I have reached the stage of "stuff it, who needs sleep anyway". The previous nights were absolutely crackers, no sleep whatsoever, so last night came as a welcome change.

And if you are reading this MP, thanks for the shift swap, I think you owe me one...or at least four hours of working!

first night

2009-09-11T16:23:00.000+08:00

First of the nightshifts in this set of four saw me in the drivers seat again. The weather had been somewhat rainy, resulting in a couple of prangs (car accidents). This is what was flung at us:

Car vs tree:

If you drive a ute, chances are that you are young, male, and don't like slow cars in front of you.
If you are a ute, chances are that you don't have much weight on the back wheels.
If you are a wet road, chances are you won't offer an accelerating rear wheeled drive ute much traction, thus causing said vehicle to spin 180 degrees and land in a tree, backwards.
If you are the driver of the above mentioned car, chances also are that you will be embarrassed by your mother turning up at the scene and picking you up.
If you happen to be the nice ambulance people that turn up, chances are they don't want to play in the pouring rain, and are more than happy to oblige to your decline of any emergency treatment. Next job please!

Car vs pedestrian:

According to witnesses (we never really got to see the offending person), someone was running in and out of traffic, and got hit by a car. Someone called 000 for an ambulance. By the time we arrive, he has waddled off. Area search, no trace. Next job please!

Altered state of mind, incontinent

Yum, fecal incontinence. A first for me, and hooray to the heavens above that I was not attending that night. Gave patient a quick shower, I practiced the art of mouth breathing, and a fresh pateint emerged and was loaded in to our ambulance. Easy.

Altered conscious state, post collapse

Female possibly, most likely having a stroke. Patient not overly responsive, so we weren't overly fussed about red lights on the way to hospital, and turned on our funky disco-get out of jail free-get out of my way lights.

Female, 70's, pain to elbow and hip post fall

possibly fractured femur. Ouch. Lots of pain relief, some splinting, a gentle transport to hospital and were off. No more jobs please, it's 1 am and I would like a nap.

Female, mid twenties, contractions 4 mins apart

Here we go again...I am getting too many of these jobs. This one had its own flavour though, she was suffering from a strong bout of tachysaviourism, a quite vocal condition where the patient repeatedly and loudly starts praying to our apparent saviour Mr J. Christ. Anyway, our patient walked on to the ambulance. Because we didn't want to stay and play, and would rather have a midwife or two helping out in such a scenario, we did a runner to hospital, and left her in the capable hands of the maternity ward. No more jobs please.

Some kind of job, can't remember

You know when you are at a traffic intersection in your own car, waiting at a red light, and an ambulance pulls up beside you? and then after 10 seconds, said vehicle apparently can't be bothered waiting for another few minutes for the lights to change? Well, that was us, getting a priority one, hitting the sights and lirens and leaving our poor onlookers to stay stuck in traffic...

Car vs Car

Last job of the day, and a near perfect circle. Ute, wet roads, young male driver. This time with some added spice, such as alcohol and hitting another car, whose driver turned out to be our patient. I won't go on about road rules, but allowing young drivers to drive seriously unbalanced (remember, no weight on the back wheels) high powered cars (360 horsepower) is just plain wrong and dangerous.

We got to the accident scene all right due to our funky blue red and white lights, but getting to hospital took ages in peak hour traffic. We ended up back at station two hours after official knock off time. And started 15 mins early. Which makes for a 16 1/4 hour shift.

Last night (post coming soon) we didn't get any sleep. Doing an extra night shift tonight, and it's friday night. Expect some teabags under my eyes. Earl Grey or English Breakfast, the choice is yours.

Death by Ambo?

2009-09-10T21:08:00.000+08:00

Nonagenarian patient. Partner asks him if he has ever had any loss of consciousness.

Partner: "Have you ever been knocked out before?"

Patient: "Yes. By Ambulance Drivers"

Loss of consciousness, no loss of humour :-)

May I introduce to you...

2009-09-09T09:54:00.000+08:00

I wanted to write a catchup post on my last nights shifts, but I can't remember the jobs, and the scribblings i kept are at the depot...so we'll have to wait for that one.

Instead (well not instead, this post was planned as well), I shall introduce you to two of my colleagues:

Under the Red and Blues
http://undertheredandblues.wordpress.com/

and

Vollie Ambo
http://vollieambo.blogspot.com/

Both of the boys are from country depots, and a volunteer ambulance officers. I'm feeling a little hazy at the moment, and therefore will not get in to the depth of how our system works, and anyway, that would warrant a post of its own.

Anyway, pop over to see what country WA is like, and if you have some spare time, come down for a holiday. Especially now, when the wildflowers are out!

(Caltryx Depressa)

L for LOSER

2009-09-08T21:35:00.000+08:00

Only a loser would believe that, the day he stays away from the depot, the depot gets two resuscitation jobs in a row. Luckily I still had my doubts...

Yeah, so my highscore in the below mentioned game is 5. Thise two dodged one from yesterday don't count, I got carried away.

BUT, and yes, there is a but, I have to start counting from scratch today. Because I had my first resus.

And he lives.

Which makes for an excellent statistic. If you keel over and die, I'm your man. All my CPR patients have survived my poundings.

Just don't give me another one. That would ruin it.

Extreme Resus Dodging!

2009-09-07T18:33:00.000+08:00

Y'all been having fun out there?

No?

Things getting boring? Need to try something new? That little extra that will tickle the last bit of adrenaline from your ad renal glands? Then look no further, try...

EXTREME RESUS DODGING!

TERROR! AAAAAAARRRGGHH!

- ~ -

The rules of combat are easy. You have to attend as many jobs as possible that have a strong hint of "resus" in the air, or even better, "CPR in progress" written in the job description. Then, turn up to the job, all psyched up for some pumpy pumpy action, and do absolutely nothing...because there is...nothing to do. Do this as often as possible; the first person to actually come across resuscitation efforts loses, and the winner is the ambo with the "most dodged resus jobs".

My count so far (in 5 months): Dodged resus jobs: 7, real resus jobs: ZERO. Zilch. Nichts.

In no particular order, they were:

Male, unconscious, CPR in progress: Turns out to be a nonagenarian who had a syncope (faint)
Male, unconsious, post submersion, CPR in progress: Bloke who thought he could swim underwater for longer than his friends. He could...luckily his friends fished him from the pool and performed CPR until said friend woke up and spewed water in their face.
Female, not responsive, caller unable to do CPR: DOA.
Male, suicide, CO2 poisoning, apparently resus in progress: All that, minus the resus.
Male, post fall. On arrival, our patient was white as a sheet and had extreme bradycardia (slow heartbeat). 10 minutes later in hospital, he arrested.
Plus various little other jobs where a hint of CPR could be smelled, but did not turn out to be (don't really count.)

Today takes the cake though. I did a shift swap with a fellow student, so I could have the day off for a nice long weekend. He did two resuscitations, in a row. Back to Back. Wow.

Normal day to day operations will return tomorrow at my station, I'm sure. Until then, I will be happily dodging my way through the resus jungle....

farking autosave

2009-09-03T14:16:00.000+08:00

OK, just lost 40 minutes of writing about my last two night shifts. Fuck.

Auto save is great. Except if you acidentally delete all the text to write something else, then autosave kicks in and saves....well, blank. How to revert to old autosaves? Nein, das gibt es hier nicht.

Oh crap. I am heading back to bed.

My Office

2009-09-01T10:36:00.000+08:00

I have deprived you, dear reader, from seeing my office environment. So you don't have to go out and hurt yourself to see where I work, I will (virtually) invite you to my workplace:

A few details:

Van: Mercedes Sprinter 315

Panelwork: Paull & Warner Mark VI

Emergency warning systems: AWS 1500 Series (I think) plus additional Code 3 LEDs.

Some equipment:

Zoll M Series 3 lead ECG Monitor
Stifnek Cervical Collars (adult only)
Zoll Soft Collars (adult + paeds)
Carry Canvas
Ferno 50/50E stretchers
Sandbags
Cardboard Splints
Manual BP cuffs
Bags: Meds/Trauma/Airway/Oxygen.

The two seats on the left actually swivel and fold down, and thus can be used as an extra bed for lying people down (complete with harness). Good for country use with limited resources and mass casualty incidents. In the eastern states they have a little working table instead of the middle seat - probably a better idea.

These new vans are quickly outphasing the older Mark V vans - and so they should in my opinion. The new ones have a few good safety features (LED Lighting, day glo yellow livery, ESP, 6 airbags), and some thought has been put in to the back (more and bigger handrails to hold on to, more cupboards, all seats with 3-point seatbelts). The interior lighting is far superior. Plus there is a handy little table in the back in case you feel like a game of cards.

Best of all, I get to drive a mercedes for work.

second is first

2009-09-01T09:52:00.001+08:00

Went Paintballing on Sunday. I was supposed to be working that day, and, to be honest, I was hoping I would not get the day off; I am a big wuss at times, and the thought of little speedy pellets filled with paint hurtling towards my delicate skin with breakneck speed did not sounds like a walk in the park. But it also sounded like heaps of fun, so I did go, and blimey is was good. I had a ball (yes, pun intended).

Back to topic: Arriving at work back for my first day, but the second day of the set of four. As I mentioned before, I like to drive on my first day back, and I erroneously put all my gear on the drivers seat, until my crewmate rocked up, and moved it to the 'hot seat' (hot seat: the attendants seat). Of course, my turn in the back today, duh!

Not much happened that tested me, here is what we did (wait a second whilst I just grab my notepad...Damn, left it at work. Go Go Gadget MEMORY!).

Check van
Read email.
Watch first 20 minutes of reservoir dogs.
First Call: Patient with lump in groin, relatives could not get patient in to car, so we got patient in to our car.
Transfer from LittleHospital to BigHospital. Child with respiratory distress. Hospital gave appropriate meds, and kiddiewinks slept throughout transport. Easy.
Something
Something else
Watch last 20 minutes of reservoir dogs.
Patient collapsed in dentists chair. Patients humour still intact, he states he fainted when he saw the bill.
Realise I have splitting headache, take panadol
Back to station, lie down for twenty minutes.
Night crew arrives to take over. Pack my stuff and leave.
Home, eat, sleep.

Easiest. Money. Ever.

2009-08-28T10:24:00.003+08:00

The phone rings at 0715. Luckily I have a small little female personage that shares the bed in my republic that answered the phone for me.

Turns out it is the rostering department, asking if I were able to pop over to one of the depots to fill in for someone who has booked off sick. "Yep, no problems, be there as soon as possible!". Shower, iron uniform, hop in car, drive to UsualDepot to pick up necessary accessories (epaulettes, name badge, belt, hi-vis vest etc...) and on to OvertimeDepot. It is a beautiful sunny winters day, the traffic is not too bad, so I get to work in good time. I arrive, say hi to my paramedic, he's checked the truck and got everything ready. I do my few re-checks (to be sure, to be sure), and off we go to a transfer that comms have been holding for us: 90+ year young lady, to hospital for some further treatment. Bright old spark, and being admitted to a hospital with mag-bloody-nificent views of the water. She'll enjoy her stay!

On the day went with another transfer and a minor job, In between we saw the RAC Rescue Helicopter (a.k.a. "The Chopper") land outside of hospital. Cool.

Then we took a Neo Natal Transfer job from another crew that had been closer to an emergency call. You see, transfers are usually put down as 'non urgent' (understandably). If you are heading somewhere on a non-urgent call, and an emergency pops up in your vicinity, you get diverted to the higher prioritized call, and another crew will take over your not as urgent call (or if it is really not that urgent and noone else is around, you do the high priority one, and then get back to your old non-urgent call!).

Neonatal Transfers are interesting. You head over to the Kiddies Hospital, grab a neonatal retrieval cot, and stick it in your ambulance. Don't forget to grab the NETS Team, the Newborn Emergency Transport Service (a good bunch, they are always happy to teach you one or two things along the way). Fully loaded, you go to wherever the sick child is, drop the team off with their cot, wait around for them to do their magic, and then collect the tam, cot and baby to return to the Kiddie Hospital for further treatment. An easy job, as all medical stuff is done by the NETS doc and nurse. All their gear leaves no space for us in the back, so generally the attendant sits in the front too...and that also makes our paperwork much more easier. Plus, these children are usually not on the healthy side - so although the transfer has a low priority, you are contributing much more to the health system by doing these jobs. Better than picking up drunks from the side of the pavement!

And to finish this post off, a bit of a NEE NER stick-tongue-out-at-you moment: All overtime is double time. Plus a bit extra because they called me in the morning on such a short notice. While the money clock was ticking away at double speed, I managed to clean my car, read the paper, do a few transfers, sit down and grab some lunch and generally have a real easy day. This job just gets better and better!

WOMBAT

2009-08-26T10:47:00.001+08:00

I could tell you about the seven jobs I did last night, about the shift extension, about starting early, about the car accident, about the chest pains...but I won't. Last night we had the strangest of calls...

Deep in my Rapid Eye Movement phase of sleeping, we had had just over an hour of downtime at the depot since the last call. All is quiet, all is peaceful, until BEEP BEEP BEEP BEEP! a non urgent call comes through for us. I crawl out of my sleeping bag, stumble in to my boots and in to the ambulance.

My eyes are still dry as the sahara desert, and half glued shut. The world though my eyes is currently more of a reminder of those 'don't drink and drive' ads, everything is blurry and doesn't make much sense. Neither does the message on our little screen. "Patient hit with didgeridoo a few days ago, hand now hurts". Huh? What? Why? It's 3am! Our communications office calls us, apologizes for waking us up, and tells us that the call came from health direct, a phone line for medical advice. Health direct told them to call an ambulance, and so we must go. And we did go.

Pulling up in a nice part of town, we enter a not so nice house. And our patient has definitely hurt her hand, she has a fairly deep cut. And...there is something around the wound....it can't be, can it? They look like SALT CRYSTALS. The wound was absolutely caked with salt. We quizzed the family what was going on, and were told our patients sister had recently completed a first aid course, and wounds need to be kept clean, hence the generous application of SALT and...PINE O CLEAN. Yes, our patient had a laceration that was filled with salt and household cleaner.

Inside, I cracked up, on the outside, I gave a good hearty grunt of enjoyment to the world, as so did my crewmate. Mixed with disbelief.

I am still perplexed.

...and if you want to find out what the title of this post means, have a read here.

It started out promising...

2009-08-25T11:06:00.001+08:00

Less people need ambulances at night (exceptions are Fridays and Saturdays -> partygoers). Generally the public are tucked away in bed, out of trouble. People who are asleep don't trip on the pavement, they don't start fights, and they don't drive (well, some do, but that's another can of worms). But - the number of ambulances out on the road is nearly halved at night, plus there aren't any (non emergency) patient transport crews out at night. So it is generally busy.

So, last night the job numbers picked up from the day, six or seven if I remember correctly. It started off with two genuine priority ones:

A patient who had overdosed, we later found out they were TriCyclic Antidepressants (TCAs). Luckily the police pulled up the same time as us, as our patient was behind a locked internal door that needed kicking in, plus the boys and girls in blue are great for getting background info from family/bystanders and are always handy and willing to help with a lift. And for those in the know: apparently our patient had taken 2.5 grams (!) of TCAs.
A twenty-something year old complaining of chest pain. A message like this always arouses suspicion; young hearts don't often have many problems, more often than not calls like these turn out to be abdominal pains, or of musculo-skeletal background (heavy lifting anyone?). Anyhoo, we still treat it as genuine until proven otherwise, so we flick the lights and sirens on and whizz off. Upon arriving, we see our patient in bed, visibly upset. Chest pain not as such, but a 'funny feeling'. My partner takes a radial pulse, but can't count fast enough. The SpO2 probe goes on, and so does the ECG. We diagnose Supra Ventricular Tachycardia (SVT). Essentially a fast heartbeat. And this one was fast, we clocked her at 260+ beats per minute.

After those two eye opening, slap-in-the-face wake up callouts, the night just bumbled along, with nothing special to report. Actually, I lie. Our last patients next of kin was not only very easy on the eye, no she also filled our Patient Detail Form out in...Detail! Name, phone number, date of birth is standard, meds is always a plus, but recent blood gas results? Wow!

Off to bed now, and do it all again tonight, this time I get to snooze on the way back to the depot, as I don't have to drive. Yeah :-)

Slow days

2009-08-24T12:07:00.001+08:00

A Picture for your amusement. I do have to say, most drivers here are pretty good, and some are brilliant (thinking ahead, leaving us space etc) when we are on emergency runs...but you always get the odd one who just does not get the picture of MOVE TO THE LEFT.

- ~ -

Well, we did end up getting 3 calls on Saturday and 5 calls on Sunday. Both times our last call came in at 1730 - so we got some good overtime in, but then again I came home later than anticipated, slightly tired and bloody hungry. Note to self: take more food to work, mini Milky Ways are not the greatest in fighting hunger.

Saturdays jobs were nothing out of the ordinary, a transfers and two jobs where the caller really hammed it up in order to get a quick response. Gotta see the positives: I get to drive through red lights :-)

Sunday jobs were as follows:

Severe back pain
Elderly gentleman with a 'fuzzy feeling', home Blood Pressure measurements were slightly high. Could have taken a taxi, but a nice'n'easy job for us.
RFDS Transfer. Patient walked from plane to wheelchair, from wheelchair to ambulance. I suggest that we get interchangable panels on the side of the van, so depending on occasion we can display what we are (like buses have). Some signs I would want: "AMBULANCE", "TAXI", "GET OUT OF THE FUCKING WAY YOU BLIND BAT". Patent Pending.
Shortness Of Breath, history of emphysema
Another one, this time in medical speak: SOB, Hx of COAD. Don't you just love abbreviations?

The first job was interesting, we had been warned our back pain patient may be violent, but was lying on the floor unable to move. At least he wouldn't be running after us if we got on the wrong side of him.
Luckily, his train of thought mimicked those of most of our clients; he saw us as his mates, people who actually took him seriously and would provide him some pain relief, plus get him to hospital comfortably.
That sounds corny, but here is why: He states he loves his parents, but cursed them for not having much empathy for his pain. He was lying on the floor unable to move, but they (parents) just told him to get up and walk to the car, gave him 4 panadol (Tylenol for the US folks out there). For their compassion, he somehow got hold of a walking stick and apparently poked his dad in the chest with it - hence our 'violent' patient.

kicking back

2009-08-22T10:04:00.004+08:00

Currently sitting at the depot, feet up, back rest near horizontal on one of the recliners. I realize that my last post was all over the place and reads 'busy', but that is exactly how I felt after the shift, when I wrote the post.

2 hours in to my shift, and still no calls. I'm going to go out in to the stores room now, and squirt some atomised saline up my nose. We use these devices to apply Intra Nasal Fentanyl for pain relief. Of course, squirting stuff up your nose can be a tad uncomfortable, so it's important to know

---

Quick interlude: just got a priority one, unconscious person. Accepted the job, just about to put the address in my satnav, and then got stood down, as "person is now conscious, and we aren't required".

---

how it feels to the patient, so you can honestly tell them how it feels. We also did this with thin flexible oxygen catheters up our noses in induction school. Yuk.

I draw the line at intubation, though.

My First

2009-08-19T11:05:00.006+08:00

Outside forces are recalling memories. These forces stem from Mark at Medic999, asking the simple question: "What was your first ever emergency call?".

Here goes:

We were having a grand time. I was with a group of long-time friends, and the whole inner city had been blocked off because of the festivities going on. Beer, Wine and Spirits were flowing in generous amounts around me (mind you I take it pretty easy on that stuff), and a good time was being had by all.

A mate of mine and I decided to catch up with another group of friends; we had heard they were sitting in the nearby park. So off we trundled in to the dusky evening, leaving the merriness of the streets behind us, and just talking about random things that came to mind. We entered the park, walking in the presumed direction of our mates, when a bunch of spotty teenies cross our way, and surround the two us. It it completely dark by now, and the bastards shine torches directly in to our eyes.

Spotty Teenie Kids: "Hey, we are police."

This is followed up by some primate-type grunting/laughing, a la Beavis & Butthead. Yeah right of course you are police. You can't even wear you cap around the right way. They continue:

STK: "Hey, you, how are you going? You got a mobile on you? We have to check it."

I silently consider my options. Running away could be tricky - my friend just came out of hospital from a hernia operation 3 days prior, quick movements are out of the question. I myself only had thongs on, not the best of running gear. Plus, there are about 10 of the buggers surrounding us. So far they only have torches, but I do know what these types of kids often carry around with them...and I didn't want to push the limits to find out. So, in a bit of an anticlimax for you, beloved reader, we hand over our mobiles and my mate also has to hand over his wallet (I somehow got out of that). And off they run in to the darkness.

Now, all that built up adrenaline comes rushing out in to my system - my mind and body are free to work again, without the fear of knives being produced. I need the police here, pronto. But don't have a phone to call them.

I need a bystander with a mobile phone.

Running off towards the edge of the park, I find a couple sitting on a bench. I note they are doing something, but I am focussed on getting police assistance ASAP: "I need your mobile phone to call the police, quick!" I shout. They look startled. "Do you have a mobile on you? I need to call the police, we just got robbed!". The guy slowly pulls a phone out of his pocket with a 'What the hell is going on' look on his face. I dial the number for the police, and hand the phone back. Startled couple still look startled, and hush off.

Well, it turns out I missed a vital bit during those few moments, my mate tells me later. The couple on the bench were just preparing a line of cocaine to snort, when tunnel-vision-me comes running up and demands their phone to call the cops.

I would love to know what thoughts were running through their mind at the time...

Seize the day

2009-08-18T11:47:00.004+08:00

PFO - a common acronym amongst ambos: "Pissed, fell over".

That's probably what our first patient of the night was suffering from. On arrival, the staff of a nearby supermarket that called us told us that said patient had ridden his bike drunk, fallen over, split his head a bit, and rode off in to the up and coming night. We did a good search of the parking lot, the surrounding parking lots and the road where he headed off to - Area Search, No Trace. So I get on the two-way, and let our control room know what is happening: "Area Trace, No Search". Oops, that came out wrong. Damn you, Area!

Then directly off to a man with a extremely painful knee, probably due to his medical history. In my eyes he must have underestimated his pain on the 1-10 pain score, or did not want to admit in how much pain he was, but you could see he was in real agony. We took our time on scene, except for the pain relief that went straight in and worked a treat. Our patient became a happy man with less pain, and his wife and himself were extremely happy for our help. To their credit, they did try and call a GP, but it was just after 1800 hours, and the GP only starts to see people after hours after 1900 hours. Our patient could not sit in one spot for longer than 5 minutes for so much pain, so I fully support the need for an ambulance.

Just over an hour at the depot allowed us to grab some food, finish a van check (we started out shift 15 minutes early) and relax, before we sped off to our next patient, an assault victim. Turns out he had been drinking all day and wanted to drive home, and his family did not want to allow this - a minor melee broke out. Scene was controlled and calm when we arrived, thanks to three police cars and six officers on scene (thanks cops!). Pt was not very rousable, but therefore very drunk, but perked up with our treatment in the van. We weren't too sure about his injuries, it didn't appear to be serious. But my x-ray vision wasn't working last night (I didn't use it, wears the battery out), so to be sure, we wanted to get him checked out at hospital. Enter hospital, enter ramping, enter unhappy side of patient. He climbs off the stretcher, rips his cannula out, saline and blood flowing everywhere, exit patient. That's one way to get unramped fast...

We were then directly sent to a child, given as post seizure if my memory does not elude me. Luckily the call got cancelled about three minutes before we pulled up at the house, the parents had probably gotten tired of waiting and driven to hospital themselves. Good parents.

Back at the depot and off to bed for...a few minutes, only to be awoken again for a Priority 1, Asthma attack in a young girl. We were told that the childs own medication had been adminstered, but to nil effect, and kiddie was extremely short of breath. Ambulances are great, you turn the key, pedal to the metal and they're up to speed. Unfortunately ambos are not like that; I was going through all my treatment options, looking up drug dosages and possible repeat times, and just to be sure I went through paediatric CPR procedures. We didn't speak it out loud, but my crewmate and I were expecting a not too happy scene, with a not too happy child.

Upon arrival, I was relieved to see the parents not standing outside, waiting for us (that's usually a bad sign). They did appear two seconds later...they must have been waiting for us in the hallway, in the warmth (Good Parents with Common Sense). Directly in to the van, kiddie was screaming and having a good amount of trouble breathing, you could hear the wheeze from a mile away. In go our drugs, kiddie not too happy about it but hey, you gotta be cruel to be nice occasionally in this job. We continued treatment en route, our patient getting better minute by minute, until she actually stops crying, coughs occasionally and starts smiling and talking. Good, we could help, and my level of alertness could be lowered a level...I had a splitting headache at the time (which I only realised then). Handover at hospital was uneventful, the nurse gave me that look of "why are you bringing HER in?" Well...you should have seen her at the scene, you would have soiled yourself.

On a side note, the sex of the child was difficult to tell from its name, it was one of those new fashionable ones (I guess). Also, the kid could have looked male or female. The only reference I had ever heard to this name before was a friends dog.

Back to the depot, back to bed, just over an hour of sleep and then it came again. Beep Beep Beep Beep, Priority 1. This time, post seizure. He was post ictal on arrival, but perked up with our treatment, and off we went to hospital for further checkups. A nice enough fellow, with some stunning family photographs at his home.

Repeat procedure, back to bed, but this time only half an hour in bed then another Priority 1 for us - seizure (hence the title of this post). On arrival our boy was either post ictal, or still in a very minor seizure, couldn't tell. He started to twitch again, and together with the information from the parents we decided to give our drug of choice and get to hospital sooner rather than later. I was attending that night, so usually the driver gets all the extrication equipment required for the job, but on this occasion I volunteered to get the carry canvas, a sheet with handles you can slip under patients and carry them around narrow hallways. Our patient had been incontinent (common during seizures), and I desperately needed a breath of fresh air. Sounds pathetic, but it was good to be away for 30 seconds to give my nostrils some relief. I don't think I will ever forget to check for signs of incontinence in post-seizure pateints from now on. Back in the room with some fresh air and lavender thoughts, we grabbed our patient, placed him on the stretcher, back in our van, and whizzed off to hospital. During the trip, he finally stopped seizing (after 45+ minutes!). Mum was in the back with me, and as calm as lamb in a green pasture on a spring day. She had put up with this years, accepted it, and acted accordingly. She was really helpful en route, answering all my questions, helping to keep the position of her son on the stretcher (recovery position is difficult when patients wake up), chatty, and dishing out a joke or two. In stark contrast to last nights mum who wanted her daughter in hospital for a common cold...

Well, that was a good night, with a few job where I really needed to use my brains, and a few lessons learnt. I still have the smell of incontinence in my nose, even after a shower, clean clothes and a nap. My colleague, in stark contrast, had to ask me after the job if he had been incontinent. He seems to be one of those smell-deaf people (or whatever you call people without a sense of smell). Cut out for this job, I say.

---

So, some of the above descriptions are a bit vague and I would have liked to give you more information, but going by our media liaison guidelines I am just not allowed to. This job just aint worth risking it. Hope you understand.

Thanks for reading my ramblings, turned out to be a long post after a long night.

	Australian College of Ambulance Professionals WA Branch Inc
	E: secretary@wa.acap.org.au
	A: PO Box 335 Belmont WA 6753
	W: www.acap.org.au

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