Seize the day

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.

ramping nights #2

We brought our first patient back to hospital, and upon nearing the Ambulance Bays at ED, all we saw was a sea of green. The picture does not do the situation justice, we were in fact the ninth (!) ambulance pulling up at hospital - I couldn't capture all the vans in the parking lot. Four or five vans is usually a high number...but nine? All hospitals were ramping at that stage, and I guesstimated that roughly half of the services ambulances were tied up at hospital and not ready for emergency calls. Even one of the admin staff asked me what was going on, as she had been told by patients "I called an ambulance, but it never came, so I came to hospital myself". To put the record straight, in such cases it must have been a low priority case - if you want an ambulance, you will get an ambulance...you just need to wait long enough. I might post later about priorities, apparent time wasters etc...

Anyway, we stayed in our local area last night for a change, and did the following jobs:

• Person with chest pain in car, pulled up on side of the road. It was dark, and we had our emergency lights on to (hopefully) protect us from traffic hitting us. I was treating the patient in the back of the van with my partner, when I notice an additional set of blue and red flashing lights outside. I peek through the window, and see a police car pulling up. Cop gets out, I open the door, and all is well. They saw us and just wanted to check up if we needed a hand. I'm still touched - Thank you guys!
• Abdo pain with violent vomiting, inducing haematemesis (vomiting blood). Poor fellow.
• Transfer from public to private hospital. Fellow was a nurse of 35 years, very pleasant chap.
• Fall or collapse, wife found him on floor. No injuries, but underlying medical conditions meant we took him in to hospital just in case.
• Early morning Acute Pulmonary Oedema. Ramping and APO both nights...I am sensing a theme!
• Last call was an interesting one too. Call to a middle aged male, complaining of sudden onset of dizziness and nausea. Now, for a layperson, they would go back to bed and either a) wait for the world to end, or b) for things to get better. What? Our patient says their anti emetic (against nausea) medication didn't work? Where did you get that stuff from? Oh, you're a doctor. Aha. You have too much medical background knowledge, and you now believe you are suffering from a posterior MI (heart attack, back side of the heart).

Poor fellow. Getting carted off to a hospital where some colleagues probably know you and who will now treat you...what a feeling. Deep inside you probably know that you got up too fast out of bed, but these symptoms could also be cardiac related...damn you, medical education!

I sympathise with that, last year I had chest pains and went to the doctor. It was worse on inspiration, a twelve lead ECG was done and no abnormalities detected, and it went away the next day - a muscle strain (I had done some heavy lifting). But the background knowledge I had from uni was just getting to me, so I had to get myself checked out. Better safe than sorry!

OK, enough rambling now, it's 0255hrs and I'm wide awake but in a haze. Shouldn't have slept as much after coming home from nightshift. Damn shift work, has it's ups and downs....

ramping nights #1

Ramping is a massive problem here in Australia. For those of you lucky enough not to know what I am on about: Ramping is the act of the hospital not accepting patients in to the Emergency Department due to overcrowding - the ambulance is 'ramped'. This means that the patient is still in care of the ambulance crew, at hospital, until a bed is free.

The main problem is that that ambulance is now off the road, not able to respond to emergency calls, so other crews have to fill in the void. Other crews then have to leave 'their patch' unattended to answer priority calls. On my second day shift just gone we responded to a chest pain call 21 km away, lights and sirens, because all the other crews were ramped at hospital.

We need more hospital beds. Patients are spending too much time in the ED.

Anyway - back to my night shifts. Sunday night, I got called out to the following jobs:

• 15 min Priority 1 drive to a ?unconscious patient in restaurant. On arrival the manager of the place tells us he asked the patient to wake up, and he did not respond, so our patient must be deeply unconscious. You guessed it, our patient woke up with a good sternal rub. I called him a cab, but he walked off, as the waiting took too long - not before he asked us if we had a pack of cards on us, so he could show us some card tricks :-)
• Off we then went to take over from day crew that were ramped at hospital and wanted to go home after 2 hours of overtime. They had been ramped for 2 1/2 hours, we were there another hour...
• Transfer from one hospital to another, back in to our local area.
• Then an interesting call to a poisoning in a nursing home. Good ol' Mavis (yep, you're right, not her real name) reached for the toothpaste and instead grabbed the sorbolene hand moistener. Upon realizing her mistake, she went to drink a glass of water, which happened to have (don't ask me how) a tablespoon of salt in it. Staff called the poisons information centre, who told them the mix could be potentially dangerous - enter ambulance crew. Mavis was deaf as a doorknob, but a lovely old gal, so we had a good chat (at screaming decibels) en route to hospital.
• Early morning Acute Pulmonary Oedema (APO). An interesting call, upon arrival we could hear the tell tale bubbling, so we knew we had to shift up a gear. Hospital was four minutes away, and BiPAP saved the day!
• A psych transfer to end the night.