Moved!

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

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

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

(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

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

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!

Advertisement

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

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

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!

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.

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

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

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

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!

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?

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

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

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...

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...

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/