Easiest. Money. Ever.

The phone rings at 0715. Luckily I have a small little female personage that shares the bed in my republic that answered the phone for me.

Turns out it is the rostering department, asking if I were able to pop over to one of the depots to fill in for someone who has booked off sick. "Yep, no problems, be there as soon as possible!". Shower, iron uniform, hop in car, drive to UsualDepot to pick up necessary accessories (epaulettes, name badge, belt, hi-vis vest etc...) and on to OvertimeDepot. It is a beautiful sunny winters day, the traffic is not too bad, so I get to work in good time. I arrive, say hi to my paramedic, he's checked the truck and got everything ready. I do my few re-checks (to be sure, to be sure), and off we go to a transfer that comms have been holding for us: 90+ year young lady, to hospital for some further treatment. Bright old spark, and being admitted to a hospital with mag-bloody-nificent views of the water. She'll enjoy her stay!

On the day went with another transfer and a minor job, In between we saw the RAC Rescue Helicopter (a.k.a. "The Chopper") land outside of hospital. Cool.

Then we took a Neo Natal Transfer job from another crew that had been closer to an emergency call. You see, transfers are usually put down as 'non urgent' (understandably). If you are heading somewhere on a non-urgent call, and an emergency pops up  in your vicinity, you get diverted to the higher prioritized call, and another crew will take over your not as urgent call (or if it is really not that urgent and noone else is around, you do the high priority one, and then get back to your old non-urgent call!).

Neonatal Transfers are interesting. You head over to the Kiddies Hospital, grab a neonatal retrieval cot, and stick it in your ambulance. Don't forget to grab the NETS Team, the Newborn Emergency Transport Service (a good bunch, they are always happy to teach you one or two things along the way). Fully loaded, you go to wherever the sick child is, drop the team off with their cot, wait around for them to do their magic, and then collect the tam, cot and baby to return to the Kiddie Hospital for further treatment. An easy job, as all medical stuff is done by the NETS doc and nurse. All their gear leaves no space for us in the back, so generally the attendant sits in the front too...and that also makes our paperwork much more easier. Plus, these children are usually not on the healthy side - so although the transfer has a low priority, you are contributing much more to the health system by doing these jobs. Better than picking up drunks from the side of the pavement!

And to finish this post off, a bit of a NEE NER stick-tongue-out-at-you moment: All overtime is double time. Plus a bit extra because they called me in the morning on such a short notice. While the money clock was ticking away at double speed, I managed to clean my car, read the paper, do a few transfers, sit down and grab some lunch and generally have a real easy day. This job just gets better and better!

WOMBAT

I could tell you about the seven jobs I did last night, about the shift extension, about starting early, about the car accident, about the chest pains...but I won't. Last night we had the strangest of calls...

Deep in my Rapid Eye Movement phase of sleeping, we had had just over an hour of downtime at the depot since the last call. All is quiet, all is peaceful, until BEEP BEEP BEEP BEEP! a non urgent call comes through for us. I crawl out of my sleeping bag, stumble in to my boots and in to the ambulance.

My eyes are still dry as the sahara desert, and half glued shut. The world though my eyes is currently more of a reminder of those 'don't drink and drive' ads, everything is blurry and doesn't make much sense. Neither does the message on our little screen. "Patient hit with didgeridoo a few days ago, hand now hurts". Huh? What? Why? It's 3am! Our communications office calls us, apologizes for waking us up, and tells us that the call came from health direct, a phone line for medical advice. Health direct told them to call an ambulance, and so we must go. And we did go.

Pulling up in a nice part of town, we enter a not so nice house. And our patient has definitely hurt her hand, she has a fairly deep cut. And...there is something around the wound....it can't be, can it? They look like SALT CRYSTALS. The wound was absolutely caked with salt. We quizzed the family what was going on, and were told our patients sister had recently completed a first aid course, and wounds need to be kept clean, hence the generous application of SALT and...PINE O CLEAN. Yes, our patient had a laceration that was filled with salt and household cleaner.

Inside, I cracked up, on the outside, I gave a good hearty grunt of enjoyment to the world, as so did my crewmate. Mixed with disbelief.

I am still perplexed.

...and if you want to find out what the title of this post means, have a read here.

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 :-)

Slow days

A Picture for your amusement. I do have to say, most drivers here are pretty good, and some are brilliant (thinking ahead, leaving us space etc) when we are on emergency runs...but you always get the odd one who just does not get the picture of MOVE TO THE LEFT.

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Well, we did end up getting 3 calls on Saturday and 5 calls on Sunday. Both times our last call came in at 1730 - so we got some good overtime in, but then again I came home later than anticipated, slightly tired and bloody hungry. Note to self: take more food to work, mini Milky Ways are not the greatest in fighting hunger.

Saturdays jobs were nothing out of the ordinary, a transfers and two jobs where the caller really hammed it up in order to get a quick response. Gotta see the positives: I get to drive through red lights :-)

Sunday jobs were as follows:

• Severe back pain
• Elderly gentleman with a 'fuzzy feeling', home Blood Pressure measurements were slightly high. Could have taken a taxi, but a nice'n'easy job for us.
• RFDS Transfer. Patient walked from plane to wheelchair, from wheelchair to ambulance. I suggest that we get interchangable panels on the side of the van, so depending on occasion we can display what we are (like buses have). Some signs I would want: "AMBULANCE", "TAXI", "GET OUT OF THE FUCKING WAY YOU BLIND BAT". Patent Pending.
• Shortness Of Breath, history of emphysema
• Another one, this time in medical speak: SOB, Hx of COAD. Don't you just love abbreviations?

The first job was interesting, we had been warned our back pain patient may be violent, but was lying on the floor unable to move. At least he wouldn't be running after us if we got on the wrong side of him.
Luckily, his train of thought mimicked those of most of our clients; he saw us as his mates, people who actually took him seriously and would provide him some pain relief, plus get him to hospital comfortably.
That sounds corny, but here is why: He states he loves his parents, but cursed them for not having much empathy for his pain. He was lying on the floor unable to move, but they (parents) just told him to get up and walk to the car, gave him 4 panadol (Tylenol for the US folks out there). For their compassion, he somehow got hold of a walking stick and apparently poked his dad in the chest with it - hence our 'violent' patient.

kicking back

Currently sitting at the depot, feet up, back rest near horizontal on one of the recliners. I realize that my last post was all over the place and reads 'busy', but that is exactly how I felt after the shift, when I wrote the post.

2 hours in to my shift, and still no calls. I'm going to go out in to the stores room now, and squirt some atomised saline up my nose. We use these devices to apply Intra Nasal Fentanyl for pain relief. Of course, squirting stuff up your nose can be a tad uncomfortable, so it's important to know

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Quick interlude: just got a priority one, unconscious person. Accepted the job, just about to put the address in my satnav, and then got stood down, as "person is now conscious, and we aren't required".

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how it feels to the patient, so you can honestly tell them how it feels. We also did this with thin flexible oxygen catheters up our noses in induction school. Yuk.

I draw the line at intubation, though.

My First

Outside forces are recalling memories. These forces stem from Mark at Medic999, asking the simple question: "What was your first ever emergency call?".

Here goes:

We were having a grand time. I was with a group of long-time friends, and the whole inner city had been blocked off because of the festivities going on. Beer, Wine and Spirits were flowing in generous amounts around me (mind you I take it pretty easy on that stuff), and a good time was being had by all.

A mate of mine and I decided to catch up with another group of friends; we had heard they were sitting in the nearby park. So off we trundled in to the dusky evening, leaving the merriness of the streets behind us, and just talking about random things that came to mind. We entered the park, walking in the presumed direction of our mates, when a bunch of spotty teenies cross our way, and surround the two us. It it completely dark by now, and the bastards shine torches directly in to our eyes.

Spotty Teenie Kids: "Hey, we are police."

This is followed up by some primate-type grunting/laughing, a la Beavis & Butthead. Yeah right of course you are police. You can't even wear you cap around the right way. They continue:

STK: "Hey, you, how are you going? You got a mobile on you? We have to check it."

I silently consider my options. Running away could be tricky - my friend just came out of hospital from a hernia operation 3 days prior, quick movements are out of the question. I myself only had thongs on, not the best of running gear. Plus, there are about 10 of the buggers surrounding us. So far they only have torches, but I do know what these types of kids often carry around with them...and I didn't want to push the limits to find out. So, in a bit of an anticlimax for you, beloved reader, we hand over our mobiles and my mate also has to hand over his wallet (I somehow got out of that). And off they run in to the darkness.

Now, all that built up adrenaline comes rushing out in to my system - my mind and body are free to work again, without the fear of knives being produced. I need the police here, pronto. But don't have a phone to call them.

I need a bystander with a mobile phone.

Running off towards the edge of the park, I find a couple sitting on a bench. I note they are doing something, but I am focussed on getting police assistance ASAP: "I need your mobile phone to call the police, quick!" I shout. They look startled. "Do you have a mobile on you? I need to call the police, we just got robbed!". The guy slowly pulls a phone out of his pocket with a 'What the hell is going on' look on his face. I dial the number for the police, and hand the phone back. Startled couple still look startled, and hush off.

Well, it turns out I missed a vital bit during those few moments, my mate tells me later. The couple on the bench were just preparing a line of cocaine to snort, when tunnel-vision-me comes running up and demands their phone to call the cops.

I would love to know what thoughts were running through their mind at the time...

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.

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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.