expectations: met

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

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

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

- ~ -

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

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

Last monday

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.

catchup post, dayshift just gone by

• 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.

It started out promising...

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 :-)

Friday Nights

An easy start to the nigh, a lift assist.

Mind you as I re-write this blog post (about 6 weeks later), both my paramedic and I agree that we could have taken this old feller to hospital to get assessed regarding a Falls Risk assessment. We did mention this to his carer at the facility, but you never know. Western Australia currently has no scheme in place for proper Falls Risk Assessments. More on that in a blog post down the track.

The night continued with a chest pain; the patient was released three hours later after being cardioverted in hospital. We bumped in to her outside ED. Always nice to get a thank you and good bye from the healed and healthy!

On to an assault outside a pub, turns out that out patient was King Hit and out of it for a few minutes. There was a first aider on scene who took over c-spine management until we arrived, and then helped us throughout the call. Big thanks from us, but be reminded that if you are kneeling and bending over to stabilize the victims head, your whale tail will be exposed to the general public for a prolonged period of time....:-)

Quick van restock, followed by a GI restock (aka NomNom), and off to my first stabbing, the offending weapon being a pair of nail scissors (presumably). The wound (small) was near the spine, so it got checked out just in case.

Next order, one drunk teenager. Had a good chat to the coppers, the friends of the vomiting teen, and some passerbys until the parents arrived to pick their son up.

-~-

Blissfully unaware at that time, the god of opiates was brewing up

a nasty concoction in order to subject us to his full wrath....

-~-

"Female, 20's, unconscious, ?OD. Underground Train Station"

That was our info. I am attending, so I grab everything I need and proceed down the escalator. Everything but the bloody airway bag.

Peeking down the long flight of moving metal stairs, I see a couple of Transit and Police Officers standing around and attending to a female lying on the ground. And she's not doing much. Not even breathing enough. And I don't have my Bag Valve Mask on me.

Not to worry, this being my proper OD I didn't even think of using the BVM. I put a high concentration mask (Non Rebreather) on the patient. As useless as a pair of tits on a canary in hindsight, as I needed to force air in to her. Paramedic to the rescue - and shoves the Demand Head in to my fumbling hands - now I can push a button and force 100% oxygen in to her lungs. Her O2 levels perk up nicely from low 60s to high 80s. We get IM Narcan in, package her up, and off to hospital. En route she starts to come round, and is not to happy, luckily still groggy enough not to be too much of a pain.

Oh yeah, and halfway through all these efforts I got to stick an LMA in :-)

Then: back to depot, restock, revive, relive, debrief, sleep, beep, get dressed, don't stress, navigate, blue/white/red lights bouncing off the walls, fill out case sheet en route, notice it's 4am. That's why everything looks like it's underwater....it's not raining after all, there is no pea soup fog, my eyes are still partially stuck closed.

Anyway, it's another OD, Police on the way. We both arrive at the same time at the house.

Enter house, enter lifeless person on the ground, enter same thoughts as last job, enter same procedures...enter oxygen!

Gee, this guy is way out of it, not looking good. Blue, sats at 61%, airway spasm means we can only trickle O2 in to his air deprived lungs.

I try to stick an LMA in, but the spasm means no air gets in. Paramedic tries to tube him, same thing. We suction, we blast him with air out of our Demand Valve.

Our portable oxygen runs out. I run out to the van to get our spare cylinder, and change it over. My paramedic is impressed with the changeover speed, he later tells me.

One dose of IM Narcan does not touch this feller. Needs more, have to call medical control, Doc allows us more Narcan. Patient seizes ~10 seconds, then relaxes. We bundle him up, and transport to hospital. He is groggy and barely awake en route.

12 hours later in hospital he is still groggy and not easily rousable...he really was out of it. Strange what people do to themselves.

That post in three words: enlightening, entertaining, draining.

More please!