Dog Days revisited

Not much happening at the moment. Am at a suburban depot, a first for me, the past four months I have been stationed within a 10 km radius of the city. Our closest hospitals are 15, 20 and 23 km away - lots of driving.

Actually, I did cover this suburban depot once, a couple of weeks ago. We were sent from our normal depot down to cover suburbia, as we were short of crews in that area. On our way down, we came across a car accident, all we saw was a car stopped on the other side of the road with its hazard lights on. We spun around, hit the beacons and had a look. Our patient was lying on the side, a heap on the floor, breathing fast, and unable to talk. Well, obviously, as our patient turned out to be a little dog who had been hit by a car.

I got some history from the owner, whilst my crewmate tried to get IV access, but unfortunately missed due to the hairy situation we were in :-)

Enter TomTom Satnav, we looked up the closest Vetinary hospital, and took owner and dog there - luckily they were still around and accepted the dog.

Another good deed done, another life saved. Woof.

ethics schmethics

Work and study and the (lack of) sleep have been keeping me away from blogging this week. I have the notes from the previous shifts here, just no time. Assignments are pressing.

And just in case you think that I'm currently studying something that will improve patient care...I have to dwell upon the difference between ethical theories: deontological, teleological etc. You know, the stuff that saves peoples lives.

Oh well...

Hello Again!

The day started off with a chest pain. We do our paramedic bit, take her to hospital, and whizz off to our next job.

Then we called back to the hospital again, we will be taking our first patient from PublicHospital to PrivateHospital Cardiac Unit - our patient has private health insurance. Hello again, and we tell the nurse that know the background of this mornings episode of chest pain - we were there :-)

We clear after the job, and get another transfer from PublicHospital to PrivateHospital Cardiac Unit. We roll in to ED...and our patient looks surprisingly familiar. We had attended to her on our last night shift and transported her to hospital as well - and she too had private health insurance, so off she went with us to PrivateHospital Cardiac Unit.

Same van, same team, same patients. Even the same day on one occasion.

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On a personal note: it was the last day of working with my last partner. I really enjoyed it, and learnt a heap as well, leeching of years of experience being a paramedic in several different countries and positions. Thank you PTSD for some great knowledge and experiences!

Yelp, Wail 'n' Wave

We were driving under Priority 1 conditions (lights and sirens) down an inner-city narrow street the other day. One lane each direction, separated by a big curb, trees and a fence - making it a narrow one way street.

We had two SUVs in front of us that had a couple of opportunities to pull over at intersecting streets, or pull up on the (left) curb, but failed to do so. We were quickly approaching the red traffic lights, and luckily the road widens and turns in to two lanes - and the right lane was empty. SUV #1 goes to the left lane, and lets us pass, good boy. SUV #2 goes in to the empty right hand lane, and stops at the red light. In front of us, in a little stealth van with AMBULANCE written all over it, red white and blue flashing LEDs, 3 different sirens blaring. Oblivious to the outside world, the SUV does not budge for 10 seconds.

Then out of nowhere, our hero emerges: a pedestrian! Standing on the verge, she knocks on the drivers side window, waves at the driver in a "wakey wakey" fashion, and points at the big noisy flashing thing behind him. Said driver then slowly proceeds to pull over in front of the other waiting cars. No obstruction to oncoming or sidecoming traffic, no big manouvres around obstacles, just a simple merge to the left.

A big thanks to Mrs Pedestrian for being our siren extension equipment. Every intersection should have one.

(by the way, if you don't know what yelp and wail are: they're different siren tones. Here's a good example).

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.

Overheard outside ED

Today, two random stories picked up outside the ED:

#1

PTSD partner is driving, I'm attending in the back. Just before we get to hospital, he overhears following conversation in the back:

Patient: "I heard that!"

Me: "Sorry, that was meant to be internal..."

PTSD cracks up, knowing that I was spending my day in a state of VF - Violent Flatulence.

In reality, all that happened was yours truly forgetting to document something on the run sheet, and having to scribble it down hastily, muttering a quiet "shit" under his breath.

Sorry to ruin a good story like that.

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#2:

Colleague needs to listen to patients chest again with stethoscope. Colleague waits for ambulance to pull up outside of hospital, turns engine off. Driver hops in back with Colleague. Utter silence, only a slight swaying of the trees outside in the gentle breeze. Stethoscope to chest, listening to breath sounds.

Instead of hearing breath sounds, his mobile phone, located out of reach on the front dashboard, jumps to life at full volume:

I'M A TITS AND ASS MAN, I'M A TITS AND ASS MAN!

Oops.