Following Chiron

Things you might not realise...

2009-05-29T19:02:00.003+10:00

We all know there are risks associated with obesity which will seriously impact on your health and quality of life, but something not many people realise is that the problem goes beyond your life and into your death - and our attempts to return life.

I've had a few cardiac arrests now where the patient was morbidly obese and the outcome each time has been a non successful resuscitation. In addition to all of the associated health conditions of morbid obesity leading to an arrest, there are a few points you might wish to ponder...

Many morbidly obese patients are confined to chairs or beds, which is where we usually find them and are forced to try to move them to the ground before effective resuscitation attempts may begin. This can sometimes be an impossible task - anyone who has had to carry a slumped body will know just how heavy and awkward it can be, but when the patient is at an estimated 190-200kg the task becomes almost impossible. While at least 2 ambulances are always dispatched to arrests, it is usually the first ambulance with usually 2 officers who are forced to try to make this move, and while occasionally family, friends or bystanders can assist the danger of injury placed on the officers is sometimes so high that they are forced to wait for more help before the move can be made. Sometimes the patient will already be on the ground, but if the patient is on their side in a confined space or simply has too much mass to effectively roll, the result will be the same - decreased effectiveness of chest compressions which will further reducing the viability of the patient.

Of course, even once the body has been placed in an optimal position a morbidly obese patient may not receive effective chest compressions due to the additional adipose around the chest. With some obese patients chest compressions, although placed correctly with the correct amount of pressure, result in the heart being moved 'side to side' rather than compressed and effectively pumping blood to resume circulation. Sometimes it is simply not possible to achieve the correct amount of chest compression with the chest being significantly thicker.

Airway access is also significantly more difficult and ventilation harder with the bulk of the body decreasing lung inflation. Cannulation becomes more difficult which can delay IV drug administration, and one of the greatest tools of resuscitation - defibrillation - can be less effective with decreased conductivity to the heart due to the additional impedance. While many defibrillators will detect impedance and attempt to adjust the current delivered with each shock, there is only so high the machine can go before the risk of burns and electrocution to other organs becomes too dangerous.

Should resuscitation be effective, or the patient is producing enough of a viable rhythm to be deemed by the paramedics transportable, there are then issues of moving the patient to an ambulance stretcher capable of bearing their weight. In NSW we have stretchers rated to 160kg and 180kg, with patients higher than that requiring the use of a custom built vehicle for bariatric patients. As there are very few of these custom built ambulances, there can be considerable delays from when the initial ambulance arrives to confirm the arrest and to call for the vehicle to when it can arrive on scene with the required equipment. These stretchers also require a large amount of room, and specialised lifting equipment with up to 10 ambulance officers sometimes being required to lift the patient can delay loading times. Once the patient is at hospital there will be issues in transferring the patient to the hospital bed, with resuscitation sometimes continuing on the ambulance stretcher due to necessity. Of course, all of the other issues listed above still continue, with potentially decreased effectiveness of CPR, manual ventilation and defibrillation.

None of this is to say that the efforts made by paramedics, nurses and doctors are any less than for any other patient - regardless of the age, race, gender or size of the patient our efforts are always to the best of our abilities to provide the patient with the best chance of a viable outcome. Every patient deserves compassion, respect and care - every patient and their family will have fear, feel grief and loss. But sometimes we know what the outcome will most likely be, and that the factors involved will decrease the chances of that outcome being positive and we will attempt to prepare the family for this fact.

When people see us arrive at an arrest they gain hope that their loved one might be brought back - that they have another chance of taking another breath.

Sometimes they don't.

The other side of the glass

2009-04-14T15:08:00.000+10:00

Day 1:
Had a rough nights sleep, went into work and slogged through a day shift. Transported a Patient with ?Gastro and after a bit was feeling a little under the weather. Got home, made a quick dinner, decided to call in sick for the next shift and went to bed. Woke up 11pm with a general abdominal pain, thought 'damn gastro' spent the next few hours trying to ignore the pain.

Day 2:
Around 4 hours after the abdominal pain started and... other... gastro-like symptoms, I decided I'd better pop into the local hospital for some fluids and maybe an antibiotic to clear the system. Get admitted quickly (thanks friends in triage!), am reviewed and discharged a few hours (and 2 liters of fluids to get back to normotensive!) later feeling a bit better, abdo pain somewhat lessened. Get home, abdo pain gets worse.
General trend continue through day, until I notice it's starting to migrate predominantly lower right quadrant. Uh oh. Rebound pain? Damn. Rovsing's sign? DAMN. It's around 11pm and after a momentary contemplation of calling an ambulance (the people at station would never let me live it down!) I make my way back to hospital... ?appendicitis.
I'm admitted VERY quickly (thanks friends in triage!) given the circumstances where I wait for what I know to come shortly.

Day 3:
Come to think of it, at this point I hadn't slept since Day 1. Am reviewed shortly after midnight by a wonderful ED doctor who confirms my provincial diagnosis (why couldn't she just take my word on the Rovsing's sign? That hurts like F*&%). I'm sent to surgery for an emergency appendectomy. I wake several hours later, a few minor scars and, compared to the abdo pain of appendicitis I'm pain free!

The recovery:
Well I hate being limited by what I can or can't do, but hey... That's life. What I have found invaluable from the whole experience is what it's like going through the system from the patient's perspective. It's completely different from what I had expected and I cannot sing praise for the fantastic work the doctors, nurses and fellow ambo's did for me while I was admitted. As part of the Health system I've known how stuffed up the system is for a long time, but to see the system MADE to work by those inside for the benefit of their patient was incredible and once more I am proud to be a part of it.

I'll keep everyone updated with how I go from here!

EMSPA (NSW) Inc.

2009-04-03T13:29:00.000+11:00

Lately I've been caught up working for EMSPA (NSW) Inc., an Assocation of Emergency Medical Service Men and Women fighting for the rights and legal protection of their peers.

Suffice to say this has kept me very busy, but has been a very rewarding and educational experience for me. This experience has also made me VERY grateful for my time spent with the Biomedical Society, which at the time was a fun almost hobby like activity - now many of the same principles and legalities are applying (with of course some alterations), the Association is run by Committee and I feel much more at ease with the way things are done thanks to the previous experiences.

Which makes me glad that I took the time when I was younger to do these sorts of things... I tend to be a real work-a-holic, always trying to keep myself flat out doing SOMETHING - at times the weight has made me tremble but so far I've held steady. I've learned my limits - although I push them from time to time to see if they're still there, and it's only when I look back do I realise that by the age of 23, I've already accomplished things that make me proud of how I've lived my life. And I only plan to achieve more and more before I'm ready to hit the grave.

The biggest lesson I have to learn is to take more time aside from WORK to SOCIAL... But more on that another day.

Smile! EMSPA has your back, Brothers and Sisters - and we're all dedicated as hell to make this work!

All things must change

2009-01-22T12:44:00.003+11:00

Months since the lost post here, much has changed.

Firstly, the job has changed. Where I used to wake terrified and excited each morning, wondering what jobs would come down and if I would be able to handle them, I now wake tired, never feeling like I get enough rest and looking forward to the next set of days off, which seem few and far between.

Not to say I don't still love the job - the excitement still gets me and the adrenaline can still get pumped through my system several times a day on the good days, but the bad days are now more monotonous and 'auto-piloted', as if my body and mind lie in wait of 'the next big job'.

Where once I would have a slight tremble in these 'big jobs', despite knowing exactly what to do and be doing it, my hands are now calm, still - my mind sure and planning at least two steps in advance. I've approached major overdoses, CVA's, respiratory distress and cardiac arrests all with the same confident, calm approach that once seemed so comical about the profession but has now become a stable flow of my life.

The wife is frantic, her husband having overdosed on many tablets of tricyclic antidepressants, his ECG shows things are not looking good and his level of consciousness is dropping with each passing second. She runs at him, grabbing him and trying to 'help' move him to our stretcher. I calmly pull her off her husband, force her to face me and not him, tell her how she can help by finding the empty medication wrappers, let us look after him. My partner and I position him laterally, maintain his airway, oxygenate and load him into the Ambulance. The wife has left us, running from room to room as if she can hear the packets calling her, but she cannot quite work out where they are.

Secondly, I have changed. I still make the bad (good) jokes, smile frequently and small talk, but the naievity of my youth is now long gone and I can't help but feel somewhat colder inside. I realise how little of my youth I took advantage of, partying little and studying perhaps too much, and while I know technically I'll still be a youth for several more years I feel older - aged beyond my time. But I am still happy, loved and in love, if anything now appreciating more the sheer preciousness of life, so easily lost, so easily wasted and so easily enjoyed and cherished - made more than just time on this planet, an experience to hold dear and utilise to it's most full. 'On job' I comfort and counsel those who have lost, those who are losing and those who fear for their loved, I show sincerity and understanding and have been told I'm good at it - but it feels as if it comes from someone else, some other source, because in reality I am cold inside to steel myself from the emotional aspect of the daily onslaught of misery we face, and must face.

The wife is crying, sobbing into her hands. We are prepared to leave the scene and she steps up into the Ambulance passenger seat. She was unable to find the medication packets and again feels a failure and powerlessness that only someone watching a loved one dying can ever understand. I tell her that her husband is in a serious condition, but that we are monitoring him closely and will have him at the hospital shortly for definitive care. I comfort her best I can, talk with her to find out more of the details of what had happened, the little facts that at first don't come out but can drastically assist treatment. I weigh our options; try to look myself for the packets, further delaying transport but perhaps having a better idea of what we are up against, or transporting knowing some of the story but getting us to hospital quicker, where many hands make stabilising this patient much easier. On arrival the patient was talking, albeit nonsensically, but now he is only responding to painful stimuli - even then only with much effort. I decide to go with the latter, and we pull out of the driveway.

There is a dangerous balance in this job. Care too much and you can't seperate yourself from your jobs - the misery consumes you and the sheer weight of suffering crushes you. Care too little and you seperate yourself from your jobs completely - you become too cold, burnt out and resenting the patients more and more each day. The balance varies from day to day - sometimes you need to care too much, remind yourself that you are human and the importance of the decisions we make between seconds that can save or damn a human life. Sometimes you need to be cold and untouchable, shield yourself from the onslaught. As long as you can find that middle ground again, survive and endure.

We arrive at hospital and rush him into a Resuscitation suite. A frenzy of bodies, hands, minds and tools check vital signs, draw bloods for analysis and ensure the body stays ventilated,the heart beating sufficiently. The wife is moved to the waiting room for what will be the longest few hours of her life.

The world has changed. Or at least, my understanding of it has. This 'first world' country is far from it. The addage that a person is smart, but people are stupid takes on a greater understanding and the acceptance that people do very strange, often stupid things in 'emergencies' is made. People live in squallor. People live in filth. People live in luxurious mansions with bedcovers that cost more than I make in a month. People have children, children have children. People make mistakes. People get hurt, get sick, get old.

People die.

I always knew about and understood death, but there is a familiarity you make with it after many encounters. There is an essence to it, a feel that cannot be described or conveyed. Sometimes even an anticipation en route to the scene, somehow we know what we will find.

The wife has gone home, although I doubt sleep will find her tonight. Her husbands blood still moves around the body, oxygenated and delivering nutrience to the organs. He is to be transferred to another hospital for acute high dependancy care, although his outcome remains unknown.

We have finished our paperwork, submitted the report to the hospital and move back to the car. We push the little button to make us 'Available' again, and we await the next job. As always we don't have to wait long, and a siren wails off into the night, the previous job cleared from the mind as routines, protocols and plans are laid for the next patient.

All things change, but for now I know where I am in life, where I am going and what roads lie ahead.

And I am happy.

Morning Mist Part 2

2008-06-29T04:54:00.001+10:00

The mist is back this morning... Calm, beautiful, like the last breath of air the earth ever takes.

He lies in the grass, motionless. He's been still for quite some time, and the mist has claimed him as her own. Two dogs - his dogs - bark at the gate a meter away, one excited by this strange new game his master has come up with, the other angry that these two men were probing their master, connecting strange things to him and shaking their heads slowly.

They were young dogs, with many years left in them. Their master, also young, unfortunately did not.

The two men walk back to their van, nodding to the other men, police, that the job was done. Their breath mists in the cool morning, tiny clouds fall and vanish almost before you could acknowledge them...

Two dogs bark, the men drive away, leaving the master in the care of the mist.

Car vs Pole

2008-06-14T14:19:00.001+10:00

Pole always wins.

It was towards the end of a day shift, it was becoming dark and we were looking forward to heading home for the night. Dispatch, as usual, had other plans for us.
"We're going to send you down to a MVC, no details at present - unknown patients unknown status".

The Mobile Data Terminal (MDT) flashed with the job and we ran lights and sirens to it. I threw on my fluorescent safety jacket and gloved up - I hate jobs marked 'unknown status'... Even though the descriptions are usually wrong, they put you in the mindset of what to expect. Unknown means you might get there to find a parade of elephants storming through... or maybe not.

We arrived shortly after, a crowd had gathered around a car wedged between a brick wall and a pole - the opposite side of the pole to the road... Now that takes effort. The car was empty, and it took a moment for people to respond when I asked 'Was anyone hurt? Who was in the vehicle?', a young male sheepishly walks forward.

On examination he seemed fine, and although we made numerous offers to take him to hospital he refused - our examinations only go so far, there may have been internal trauma we cannot possibly detect without scanning equipment, found only in hospitals. Still, he was happy enough to make his own way home via his girlfriend - but what really got to me with this job was his attitude.

"Yeah... this'll be the second time I've done this..." he laughs. "No scratches, I'm fine."

A grin on his face, as if he's almost proud of what he's accomplished.

"Lucky there were no pedestrians nearby - this would have killed them. School finished only a little while ago..." My eyes betray my disdain, I care about his welfare but it's obvious it's not about him as a person. People like this who have no regard for others or the impact of their actions make my blood boil. It will take another accident and a life lost before anything will sink into his head.

The smile is wiped off his face, he mumbles something about going to his girlfriend and we head off. It was our last job, and I went home wandering how the story might have unfolded if any one of a million variables were even slightly different and was glad that they weren't.

I doubt he spent the night the same way.

Kids are indestructable... almost

2008-06-11T09:18:00.000+10:00

So there we were, two ambo's driving around minding their own business when all of a sudden our terminal flashes.

We have a job!

Usually this would be cause for groaning and mumbling (joking, I swear) - but this call would lead us into a late meal and thus more pleasant pay packet. There's always something to celebrate in life.

We head down for a '?#' - possible fractured limb. The destination is a sporting oval that my TO knows well, and as we head down we see a game of under 12's rugby in play - this is going to be good. Coming from a different state, I never really got into rugby - but from what I've been able to gather the game essentially consists of one team trying their best to kill another team.

We knew then that if this was going to be a fracture, it was going to be done properly - and we weren't disappointed. We pull up at the windmill (otherwise known as a person frantically waving at an ambulance * see note below) and see not too far off a boy around 12 holding his arm and looking rather sorry for himself. His arm shows us why. He'd managed to break both bones of his forearm, the Radius and Ulna, the limb distal to this break flopped painfully with each movement he made.

He still had good circulation and sensation to the hand, something very important to check - because if the break has somehow damaged the vasculature or nerves it's going to be a very speedy trip to hospital for emergency surgery. I gave him some meds for the pain which almost knocked him out. The parents were a little worried about his decreased level of consciousness, but a quick chat convinced them it was for the best - what we had to do next would be something he probably wouldn't want to remember. As gently as possible we maneuvered the arm into a padded cardboard support, the poor boy still let out a semi-conscious groan of pain, and we slung it into a supported position. The meds are fairly quick to wear off, and as we drove off to the hospital we were able to have a bit of a chat and he told me about the game, which for the record ended in a tie.

I'm not sure exactly how many people have been inside a moving ambulance, but I'll give you a hint now that they're bumpy. We kept the poor boy on pain meds but still each pot hole and bump in the road left him a little sore.

We left him with the lovely doctors and nurses who promised to take good care of him, with a promise of ice cream being heard from a nurse as I walked through the exit.

He was going to be just fine...

* Note: To people who insist on waving to an ambulance while the lights and sirens are on - please don't do this unless you're the person we're going to - or at least going to take us to the person we're going to...

Nothing like a good night jog

2008-06-07T01:30:00.001+10:00

We were called to a male pedestrian hit by a car. It's night, so we have our sidelights on as we scan the area for the accident - unsure if the driver has fled the scene or not. Two men flag us down, we assess the scene as we approach. Something about this job seemed odd from the get go, we're not taking any risks.

The men tell us they saw the incident, the car is down the road but the pedestrian - hit by the car at a relatively high speed - ran off down the opposite direction.

My TO looks at me with a look of disbelief on his face, I mirror the look to our flagging-down friends. The MDT flashes with a new notice, that the patient had ran home around the corner and called 000 from there. The look of disbelief stays with us as we head to the given address.

I'm treating officer for the night, so I grab our oxygen and first aid kit and head inside, a woman is waiting at the door and guides me to her husband. He sits in a dining table chair, a red towel pressed against his head. I swear silently to myself and start my assessment - the towel was, but half an hour earlier, white.

He was normotensive and seemed fairly stable, alert and oriented, full recollection of events and denied loss of consciousness - but he had an egg on his head that would serve a family of four. It bled fairly freely and took me a while to get under control, ample time to work out exactly what had happened. The car had hit him as he jogged across the road, and for whatever reason he had thought it was best he head home to call an ambulance... despite hearing the driver of the car call an ambulance. In these situations it's hard to determine if there perhaps is an altered level of consciousness or if the patient is always this silly.

He was, given the mechanism of injury, in fairly good shape, but we took full spinal precautions anyway much to his discomfort - collars are horrible to wear for any length of time. His head would definitely need a scan to check for any internal damage or bleeding, and we sped off into the night.

I'm trying to find out how this one turned out - the bump on the head was quite nasty and I'm curious if they stitched or glued the head wound and how the scans turned out. I'll be sure to let you know!

Lights and sirens

2008-06-04T21:18:00.000+10:00

The terminal flashes, another call has come in. It wasn't the first for the day and we knew it wouldn't be the last. Traffic is swelling as the day wears on towards peak hour. It's a 1B. Lights and sirens. We turn into a shining beacon of hope, a wailing beast cutting its way through the populous.

"Cherries." she says simply. "I like nougat with cherries."

Breathing problems. Pt is alert and oriented, severe respiratory distress.

"I've always preferred almonds." he replies, a vague look on his face as if he were remembering a nougat long ago.

"Chocolate." I contribute, "The best nougat is always coated in chocolate."

I can see I have impressed them. A smile spreads across her face and a fond grin on his. I was the third person on crew before being placed into probation, the ride along. I quickly discovered that the intense look on a paramedics face when driving is usually unrelated to the job, and I laugh at how much fun I'm having in this new job.

We race towards the patient, hoping to do whatever we can to make sure they survive another day.

After all, we don't know nougat do they like.

Laughing baby is healthy baby

2008-05-31T14:34:00.000+10:00

It was early in the morning, the kind of early that leaves you wandering who would even be awake to call for an ambulance. Unfortunately people were awake, and had called for an ambulance. Inconsiderant, I know...

The call was for a 1 month old in respiratory distress - lights were on in an instant and I ran through the checklist of scenarios in my head, equipment that would be brought and, thanks to my Training Officer (TO) who would do what for each scenario with what drugs and treatments we could use.

We got to the address quickly and got into the house, anxious father in tow. In front of us sat the 1 month old, a smile from ear to ear in a warm blanket in Mum's lap.

We ask what had happened, the anxious father tells us how his son had been sleeping, suddenly awoke bright red and had coughed up a fair amount of clear sputum and had gone back to sleep. My TO grins - with 5 kids of his own he knows full well what has happened and later tells me this story is not unusual for first time parents.

It is easy to forget that babies aren't just little people - their brains are still wiring up and many organs aren't fully developed at birth. A good example of this is that babies lose their swallow reflex when asleep - and as was the case here, as saliva is continually produced the baby wakes after having a minor choke on the unswallowed saliva. After getting that out of the way, they usually just go back to sleep - if the parents hadn't been there they would never have even known it had happened. It was almost certainly not the first time this had happened, and definitely wouldn't be the last.

The relieved and sleepy trio came with us to hospital for a 'just in case' checkup, which although we didn't think it was needed were more than happy to provide.

Taken directly from my record; "Pt stable and sleepy en route", laughing to myself I thought the Pt and myself had a lot in common.

Morning mist

2008-05-28T09:28:00.002+10:00

It's the early hours of morning, my partner and I are driving back to station after a long and grueling night shift. A thick morning mist has spread across the land and as we drive down the highway I can see the vast fields around us covered with it, like a curtain trying to hide the events of the night. Maybe it was me hiding from the world, maybe I'm just overtired.

He lay in the back of the ambulance, motionless. His frail frame covered in sores and bruises from spending so long in bed. His old age was shown in every feature - from his thin wispy white hair to his lithe and withered frame. I didn't even take a blood pressure, his arms so thin I feared even the inflation of the cuff might snap the brittle bones. Baseline observations had been taken as we left the hospital, I write these down on our records.

His skin had thinned so much I can almost see the cancers that have invaded almost every major organ in his body save his lungs. Asthma and a chronic chest infection was now claiming those.

He stared vacantly out of the window, knowing his end was near. Knowing I knew his end was near. He mumbled something, it takes me a moment to realise he's asking for another blanket, and even though he came from one of the good hospitals with clean linen, I discard his spare used blanket and get him a fresh one from our linen. His eyes tell me of how much he has lost - time with loved ones, freedom to move around as he pleases, freedom from pain. Worse is knowing the final blow - his right to die at his home as he wishes. His wife rides up the front, visibly restraining herself from crying as we near the Palliative Care ward of his new and last home.

A dark cloud stayed over the ambulance the entire journey, and although I heard small talk coming from the front between my partner and our patient's wife, I know nothing that is said is really being listened to. The back remains quiet as our patient returns to sleep, possibly the only comfort he has left.

We're driving back to station and I look out into the mist. I watch it slowly cover the land and hiding everything underneath. I prepare myself mentally for the next job, a routine I've become accustomed to regardless of the patient previous. A last memory flicks into my mind before the mist covers it too - the last words I said to my patient after moving him into his ward bed;

"Well mate, get some rest, it's still very early - and Happy Birthday."
He sqeezes my hand and smiles, if only for a moment.

One month to the day

2008-05-23T20:43:00.002+10:00

As the title suggests, it is one month to the day since my last post... The reasons why are numerous and varied, but ultimately discussing them would be a waste of your valuable time. The essential thing to remember is this; I'm back, I'm a Level 1 Paramedic and I finally have time to continue this journal as such.

I've also managed to get StretcherMarks working again after a major server crash, so if you're in the industry why not take a peek and join in the fun? I even managed to upgrade the backend from Joomla 1.03 to 1.5, the new core code is much more flexible and has thus allowed me to merge a phpBB into the same login system, making chatting in the forum significantly easier.

So sit back and relax in the knowledge that some rather interesting stories are coming your way, back to the update schedule of Monday, Wednesday and Saturday.

Tumbleweed begone!

2008-04-23T21:48:00.004+10:00

Yes, it's been quiet here lately - not because anything is wrong, just because I've started my on roads and I'm flat out (and completely buggered). Good news is I have a lot of new stories to tell, I'll be sure to type them all up when I get some time off over the weekend and schedule them as usual.

'Till then, have a sneak peak at what happens when you get three ambo's stuck in one of the few comfortable waiting rooms while a Pt gets ready to be transported... ;)

I love this job...

Cool little things...

2008-04-16T12:53:00.001+10:00

One of the cool things about my course right now is that I'm backwards diagnosing some of my old patients...

Boy with big floppy ankle? Oh - he had a Potts fracture! Lovely old lady with Angina? Unresponsive to her sublingual spray and duration of pain makes that a possible AMI (and makes me very happy I called the ambulance!). Carpal spasm? Hypoventilation due to drug use!

You get the point...

Looking back on most of the patients I don't think I'd have done anything differently back then... which is a good thing I think... Doing it now, I'd do a lot more - but only because now I have that extra training, knowledge and resources I'd be more confident in my treatments. There were times when I wished I could administer advanced pain relief, confidently read an ECG or even just move the patient in some circumstances - none of which I was legally allowed to do with St John.

I guess my point today is this; from here on in I'll get to do all of the cool little things that make big differences in patient comfort and outcome...

Until of course I go up the next training scale and look back again!

Bigger than a band-aid

2008-04-14T19:04:00.002+10:00

One thing I remember happening in St John a few times was that you would get 'senior' members who flat out refused to do anything but the 'big' cases. I'm not sure if I've blogged on this before, so if I have - bugger - if not, great. Because it's something that keeps popping up in my Paramedics training at the moment...

The thing that got me with the people in St John (and I don't doubt you'd find these in every emergency medical/first aid service) who were of the 'big stuff only' mindset was that they were missing the two biggest points to do with pre-hospital care; looking after people's health and looking after people. I was extremely pleased to see that one of the steps in Protocol 1 (the very first Protocol!) in our protocol book is 'REASSURANCE'.

The people who only seek the 'big' cases (BC's for short from here on!) miss out on the real work of any good ambo - looking after people, regardless of if anything is actually wrong or not. The big test is usually if someone comes into a first aid post looking for a band-aid. Our BC's scoff at the thought of applying a mere band-aid, such is their skill and prowess that they must hold themselves in reserve in anticipation of that big fish. In my opinion, it is the humble, friendly member who puts the band-aid on the persons (usually smelly) feet, has a chat with them and walks them out the door when they're ready that is really doing the good work. Because they're fulfilling both neccessary steps of being a good medic.

Unfortunately I've seen a BC in action at an OD, the patient was transfered to an ambulance at said BC walked off grinning at what a good job they'd done. Right past the girlfriend crying because she didn't know if she was going to see her boyfriend alive again (which in that case she definitely would, although perhaps a second trip to hospital would follow his initial release thanks to said girlfriend's 'welcome home'). I remember the look on her face - desperate and vulnerable, terrified and lost. Fortunately a nurse got to her and directed her to another vehicle headed to the hospital, they had a chat before she went off and I don't doubt for a second it did her the world of good. The patients on our run sheets and cas forms aren't the only people we treat. A smile, a slight touch of reassurance, a kind word are often worth more than the most expensive equipment you can pack into an ambulance.

I know that, as often happens, I will grow tired of doing the little things. I won't want to put the band-aid on the foot, I won't want to do the simple little procedures. I like to think I'd do it anyway with a smile, or hand it to a probie (be nice to probies! please?) who needs these experiences - but not because I feel I'm above it.

They drill into us here that we are public servants in all senses - we will politely oblige the lovely old lady who has fallen over in her thirty roomed mansion. We will also politely oblige the homeless man who has passed out in a pool of filth.

I hope that no matter how much training or experience I get, I will never - for an instant - think I am bigger than a band-aid.

Heavy lifting

2008-04-08T08:00:00.003+10:00

This is a retrospective message out to the ~150kg man who briefly passed out on the basement level of an event. Myself and a guard had to carry him up a narrow flight of stairs in a collapsible wheelchair (I still don't know how we got him to fit on there...), of course I had a little trip and hurt myself for a brief time.

Still thinking of you, and looking forward to repeating the experience with your brothers and sisters out there in the world...

- Peace out.

Toilet humour

2008-04-07T15:00:00.000+10:00

One funny thing about working major events is the number of calls that lead you - one way or another - into the toilets.

Now, aside from the obvious joke that the toilet is where you'll find disgusting shit - a call into the porcelain shrines usually provides a few chuckles or at the very least a grin or two. That is of course providing you don't actually have to touch anything, and your sense of smell is tolerable of such places. But it seems that the drunk in particular have a unique affection for these places, and I'm never quite sure if it's the constant need to void the bladder after a few too many beers or the fact that somehow - somehow - they know there's nothing we love more than trying to lift a 130kg man from a pool of his own vomit, urine and... other surprises in a confined and crowded space.

Nine times out of ten you're there for a drunk who has either decided the small benches inside some toilet blocks would provide a better resting site than anywhere else outside, but there's always that other one time that keeps you on your toes and reminds you that this can be an unpleasant place to work.

Treating the drunks is usually easy - make sure there isn't some underlying medical problem, help them outside and watch them go on their way (and by that we mean anywhere but here).
Most of the time they just want to be left alone to go sleep off their little adventure, but sometimes they insist of vomiting on you, despite all efforts to convince them that it isn't in their - or your - best interest.

But every once in a while someone comes along to make your life hard. Maybe they've passed out inside a cubicle (a personal favorite, as there's usually no easy way to get into these urine-soaked domaciles without a high chance of getting yourself 'contaminated' - thankfully this has only happened to me once so far), passing out on the floor or (and I've only heard of this happening once) passing out while standing up at the urinals. Fun. I know this is something I'm only going to see more of now in the service, and it's something I'm dreading even before it's really begun.

For all the perks of this job, sometimes you have to put up with a little toilet humour.

Where's the marshmellows?

2008-04-05T08:00:00.003+11:00

Driving along one sunny afternoon in the trusty St John vehicle, my partner and I noticed a strange sight before us; a burning vehicle.

Sensing that something was off with this sight, we decided to pull over and check what was going on. Luckily the good folk from MFB were already on scene and doing their thing - but interesting was the fact that we were the only medical team there... The vehicle was very much aflame and there seemed to be some kind of high-temperature fire happening underneath the vehicle, because even after half an hour of absolutely soaking the underside of the vehicle in water and chemicals the vehicle was still merrily burning away.

And did I mention we were the only medical crew there?

We had done the compulsory 'Hi, what's happening?' with MFB, checked out the 'occupants' of the vehicle who were fine and had no smoke inhalation and spent the rest of the time sitting on the side of the road hoping it didn't all go pear shaped.

Fortunately for everyone involved, it didn't, and before long we were able to go again on our merry way. MAS had been held up at a major event for the day and so in the end we, who just happening to be driving past, were all that was available. MFB were very grateful for us stopping I think, and although we all knew fairly quickly we weren't needed, there was always that 'just in case' that made us stick around.

After all, cars and fuel tanks have known to possess a volatile relationship...

All in all a lazy job but with some pretty neat visuals to go along with it - I was happy nobody was hurt, sad that two nice people who had only recently come to Australia had lost their car and wishing that I had brought some marshmellows.

All in a days work ;)

Future in doubt!

2008-04-02T21:22:00.003+11:00

Well today we had a test. It went.

More important than the assessment of my intellectual capacity however is the patient confidentiality and privacy session we had after it... At the end of the session I asked about the policy on blogging - something I had raised several times with other trainers only to be told I should bring it up in this session. The overall picture was they didn't want it.

Tom Reynolds, a Paramedic who also blogs on the side, provided a lot of inspiration to me and was a large factor in my decision to start this blog. A fair while ago he posted on this exact issue, and this is something I'm currently using (along with a few other bits and pieces of information) to appeal this decision.

Essentially at the moment I can blog about my thoughts and views on certain topics providing they are exactly that, and I distance myself and my opinions from any service of an ambulatory nature. I am not to discuss anything to do with any patient work I may or may not have/will come across until this issue is decided.

Rest assured even if this decision is made going against my views, this blog will continue. I will still have my little vent in here about the general life, but no 'work related' issues will be brought up. I will continue to discuss medical issues and may even be able to slip in an 'example of a hypothetical situation' from time to time providing I have distanced my thoughts and views from the service.

Frustrated? Me too - but I'd rather be working towards a solution to this than hitting my head against a brick wall, so expect the next post Saturday as usual!

What you won't find in a book

2008-03-31T17:59:00.002+11:00

As a friend of mine pointed out in a comment to a recent post, there are a lot of things that don't get taught in any book. The feeling of looking at someone and knowing how little chance they have. The desperation in your heart and hands as family members look on to you pumping oxygen into their loved ones lungs because they stopped breathing on their own. The look of children on their grandmothers face as her 'chest pain' gets worse, isn't responding to the 'nice mans' medication and the ambulance is yet to arrive.

There are a lot of things that can't be taught through any book, partly because they're experiences you simply wouldn't want to share with others, partly because they can't be described in words. These are the quiet moments where you look into your soul and see yourself as a mortal being, rife with fissures and cracks - ready to break at any moment.

These are the moments when people look at you - the medical professional - and expect you to have some miraculous therapy or treatment to help the person they love keep living, and as much as I would love it we usually don't have the answer they would like.

As my friend rightly puts it, "this is definitely going to be one of the hardest things to do..."

Unfortunately it's something we'll have to get used to doing, after all, we all have to die of something - and with modern medicine people are living longer but dying in hospitals as we try to squeeze every last drop of life from their body.

The hospital giveth, the hospital taketh away.

Earth Hour 2008

2008-03-30T00:34:00.002+11:00

I am pleased to say that I participated but a few hours ago in Earth Hour 2008!

Basically it just meant turning off lights and what not - anything that used electricity. While I know the impact was only for an hour, if you multiply this out by the number of people all across the world who participated, I'm sure you'll start to see just what this is really about.

Saving coal and other sources of energy for a bit is not the point - it's about raising awareness. What started in one city (an Aussie one at that!) has spread around the world to increase awareness of the state of the environment and our impact on what is left.

If anyone hasn't done so already, check out http://www.earthhour.org/ for more details, and make sure you take part in 2009!

Thoughts so far

2008-03-26T23:06:00.003+11:00

Well, almost at the end of another week of training and I have a few thoughts about it so far...

It's intense - the sheer volume of information, whilst not overly complicated material, is overwhelming. Despite this - I love it. Even though I'm yet to go on road, the nature of the training we are receiving and the skills we're expanding on every day makes me wake up each morning (still sleepy and irritable, but also) excited and ready for another day.

But it isn't all perks. When we first got here we started a line of questioning for some of the senior paramedics, a way of getting to know the things about the job that the public don't hear. Best job, worst job, goriest job and saddest job - the story that's stayed with me the longest comes from one mans saddest story...

He was called to a possibly deceased and when he arrived, sure enough there was a deceased man laying there. He had been dead for possibly several hours, and no attempt at bringing him back was going to be necessary. He was an elderly man, the person who made the call was his wife who had found him 'sleeping' in their bed. After telling her the bad news, she sat there silent for a moment.
"But... what do I do now?" was all she asked. They had been married for over 60 years - every day together, every moment shared. She had spent vastly more of her life with this man than without, and just like that - he was gone.

These are the situations we don't have protocols for, that we can't train for no matter how hard we try. These are the hardest parts of the job and the real test of strength.

I like to think that one day I can stand in front of a class of new recruits and tell them my stories - the best, the worst, the goriest and the saddest. I just hope mine isn't so sad - but I know it will be, and that it's a part of what the role entails. I want to be good at this, and then I want to be better - I'm not doubting myself, but I hope I have the strength.

That's something you won't know until you're standing in front of that frail old lady, alone for the first time in decades and scared, tears welling in her eyes as you desperately try to stop the ones welling in yours.

Feeling faint

2008-03-19T17:17:00.003+11:00

There's something that happens on a regular basis at major music events that would be quite amusing if it wasn't so damn annoying for us - people (predominantly young girls) 'fainting'.

Now if someone has genuinely fainted, I'm all for heading over and helping them out - it's just that this is usually not the case. We have a term for this; 'playing possum', as possums are known to 'play dead' when confronted by a big scary animal to detract attention. These people do the same but to achieve the opposite - the 'patient' doesn't really need medical attention (of the non-psychiatric kind perhaps) but pretends to so that the big scary animal (me, naturally, and their friends) give them the attention they so crave. Some of you might remember I've blogged on this before.

The case that makes me bring this up again occured at (surprise) a concert where we got a call from security to attend a faint at the rear of the arena. My partner and I were the closest responding crew being at the front of the stage (naturally ;P) with the fastest route being through the crowd to the back of the arena. While it didn't take us long to get through, it's never a nice thing to have to shoulder yourself and your partner, each laden with big heavy gear through a crowd surging in the opposite direction to an aging man singing about teenage angst. Kids these days...

We arrive at our destination to find a security guard with a grin on their face - the patient 'didn't want to wait, so she decided to walk to a designated first aid post to faint'.

But as I said at the start, sometimes these faints are serious in nature. My sympathies go out to MAS who recently had an influx of such patients - although I can't vouch for all of their validity - a fair proportion have been reported to me by a worker as legitimate faints. With the warmer weather here I'm sure not looking forward to next summer!

One final thing - this article was released a few days back almost implicating the police of killing a man with capsicum spray... sneaky reporters twisting the scenario! Murderous cops sells papers, the heartfelt efforts of overworked, under appreciated and often abused (verbally/ physically/ mentally) police doesn't.

We have liftoff

2008-03-18T21:18:00.003+11:00

Well, here I am. It's now the second day of commencing my new role as a Trainee Paramedic and I'm loving it so far. The people are fantastic - the training staff are friendly and eager to teach you (although frequently reminding you that there is a LOT of content to cover in very little time), the higher level trainees and other staff keep reminding you to hold on while sharing their stories and the people in my class are awesome. They come from all walks of life, from a gym trainer to a carpenter to a physiotherapist - even a fellow biochemist!

I have to admit, so far I am thanking my lucky stars for my medical background, which has made the content so far fairly simple to learn. A lot of others without the background are starting to worry, but we're going to run some study groups lead by those who have the background (I'll be helping with chemistry, metabolism, anatomy and physiology) so that we'll all feed off each others strengths.

This class comradery was fairly apparent from word go (although most of us are still trying to figure out who everyone is!), and I'm truly inspired by the general atmosphere of the 'family' of the ambulance service.

I'm getting my uniform fitted tomorrow which should be fun - but till then back to study!

T-Minus (again!)

2008-03-14T21:10:00.001+11:00

Quick shout out that tomorrow I leave for Sydney.

Hopefully internet on Sunday, means actual post.

Till then,