Alternatives

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

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

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

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

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

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

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 -