Do you smell smoke?

Everyone in the southeast corner of Australia can smell smoke. You can clearly see smoke if you look outside. In fact you can see the smoke from space. If you don't happen to be in space you can see some amazing photos here and here. In melbourne when you look outside the horizon is gone and the streets look like it is a foggy winter's day. It is quite surreal to see. There have been some spectacular blood red and orange sunrises and sunsets giving a beautiful but stark reminder that in some areas of Victoria people are battling to save life, land and property.

I got asked if we (ambulance) have been seeing a rise in respiratory problems because of all this. I'd have to say personally no. A few exacerbations of asthma and COAD but overall much the same. Other areas may be seeing a lot more of it than I have. I asked at one hospital today and was told it had been surprisingly quiet on that front. What I have seen during this hot smoky few weeks is a big rise in heat related issues, dehydration, fainting, heat stress, and the inevitable violence and stupidity that the hot "beer drinking" weather brings.

I don't know about you but beer and hot weather makes me want to sit on my couch and watch the cricket. I don't quite understand the whole I've had half a dozen beers and now I'm going to try and stab my cousin in the left buttock with one of the bottles. Or even the Perhaps I'll get on the tram in Moonee Ponds with a chainsaw. Two separate jobs in the past 24 hours where drunk blokes had hit other drunk blokes over the head with handy pieces of wood have left me feeling like I'm missing out by sitting quietly on my couch with a coldy - perhaps I'm not drinking enough?

Fallen off the perch

First off thanks to everyone for the comments and e-mails that I've been getting. Great to hear from you all.

Here's a quick one I heard on the radio today and you'll just have to trust me, this is 100% true.

A dual car response was sent this afternoon to someone who had "fainted" at home. The cars were merrily speeding through the streets when the dispatcher came on the radio and said "Guys you can both cancel........(long pause)......it turns out the patient who fainted was a bird". Yep, someone's budgie had collapsed at home and they had called an ambulance. Of course the radio then lit up with all the predictable witty comments.

Along the same lines I'm told there is also a recording of a 000 call here in Melbourne where it was only during the over-the-phone CPR instructions that the call taker finally worked out that the patient was a dog that had run into the road and been hit by a car.

Gold.

46 years of marriage

We pulled up suddenly, almost missing the correct address in the dark street. Across the lawn with the heavy bags, I made straight for the front door which was ajar. "Hello there?" ...I pushed the door fully open.

"The door’s open" came a quiet voice from inside and to the left. My partner was just behind me and I could faintly hear the radio traffic chatting away from the portable on her belt. Stepping into the house, I tuned into the bedroom, pushing the door open with one of the bags I was carrying.

It was a neat room, it had been well looked after, but there was a dustiness to everything almost as if the house had been locked up for a long time. There was also evidence of sickness too. I took in an oxygen cylinder on a trolley, a cardboard box of tablets on the chest of drawers and a thick folder of notes from the nursing service on the bed.

There was an elderly man sitting on the chair next to the bed, who looked up at me as I came in. He had red bloodshot eyes. I asked him what had happened and as soon as I said it, I knew the answer. All he said was; "I think she’s gone". The woman lying in the bed was pale and still and her eyes were already dull. She was white, paler than natural, paler than anyone should have been.

I went round the side of the bed and felt for a pulse. Nothing. As gently as I could I asked when he had last spoken his wife or heard her breathing. He said about 10 O’clock when they had gone to bed. I looked at my watch, it was 3.35am. She was cool to touch, her pupils were fixed. I cast my partner a glance, I’m sure we were both thinking the same thing as she passed the cardiac monitor to me. I put the monitor dots on and in doing so noticed the mottled skin and areas where the blood had already settled. The monitor showed nothing.

The hiss of air brakes outside announced the arrival of the fire brigade responder crew. I was about to ask my partner to cancel them and the MICA unit backing us, but she was one step ahead of me and already heading outside to stop them before they all arrived.

I began to ask her husband about her; her name was Eleanor, she’d had cancer, it had been first found in her lungs years ago, later in her bones. As if that wasn’t enough, she had an extensive cardiac and respiratory history and had been on home oxygen for many months. Increasingly unwell over the past 6 months, she had been lovingly cared for day after day by her husband of 46 years.

I came back round the other side of the bed, took a deep breath and told him what he already knew. No matter how uncomfortable it makes you feel to tell someone about the death of a loved one, it is nothing compared to what they must go through. I will never get used to doing it. When he had composed himself I took him out to the lounge room and sat him down on the sofa. We spoke about her doctor and family members. As I explained what would happen next, he listened politely. I looked around; there were pictures of smiling young people on the dresser and some old war-time shots of a proud looking young man in a uniform on the wall.

There were voices in the other room and I realised the MICA unit had turned up after all and were asking if there was anything they could do. We tried, but couldn’t contact the patients own doctor on the phone at that time of the morning so we tried an after hours number. No luck either. It turned out there was a nephew in Melbourne, and he sounded unsurprised when we woke him and told him the news. He would be round in twenty minutes. We contacted the ambulance dispatcher and said we’d be delayed on scene until the nephew got there. We weren’t leaving until someone else was there to stay with him. When I got off the phone, he asked me if he could go and sit with her? As if anyone could deny him that after 46 years.

We both went back into the bedroom and I was pleased to see the other guys had taken all our gear out and tucked her in to bed. I walked back out to wait for the nephew. The old fella deserved a few moments.

2P or not 2P

Rob: Ahh sweet caffiene, an integral part of my day.

Rob’s Bladder: Hey moron, its spelt “caffeine”.

Rob: “I before E except after C”.

Rob’s Bladder: Yeah well there is a C in caffeine isn’t there?

Rob: Nobody likes a smartass.

Rob’s Bladder: Mate 2 cups of coffee, a glass of water and an orange juice for breakfast? I’m going to have to call in some reserve staff…

Rob: I’m ignoring you, I have a patient to go to.

Rob’s Bladder: um… excuse me? Hello? You should have gone before we left branch…

Rob: Quit your whining, we’ll be at hospital in 30 minutes and I’ll take care of you then.

Rob’s Bladder: 30 minutes! If your partner keeps driving over every bump in the road I promise you he won’t be happy about mopping out the back of the truck.

Rob: Hey it’s his job to clean the truck while I write my case notes. Besides if things get critical I can always use the bathroom at the patient’s house.

Rob’s Bladder: Oh yeah, that’s real professional, that is. “Hi, yeah look I’m sure little Jimmy’s broken arm hurts, but can I use your bathroom?”. That would go down really well with the family. Perhaps you could ask them for a magazine to read while you’re in there?

Rob: I’m done. I’m not talking to you any more.

Rob’s Bladder: Yeah that’s it, loosen your pants tough guy – it only gives me more room to work.

Rob: Look I’m busy here, And I’m sure I’ve told you not to talk to me while I’m working.

Rob’s Bladder: Things are getting awfully crowded down here. You know I can hit the override button at any stage?

Rob: you wouldn’t dare!

Rob’s Bladder: Is that a challenge?

Rob: Shhh, I’m talking to Jimmy’s mum, he’s got a peanut allergy you know.

Rob’s Bladder: Oh puleez! The poor poppet.

Rob: Will you be quiet!

Rob’s Bladder: “The squeaky wheel gets the oil”

Rob: I’ve got it under control. I’m going to keep focussed on my job and I’ll be fine.

Rob’s Bladder: You’ve checked Jimmy’s blood pressure 5 times in the last 10 minutes. Any second now his mum is going to ask you how long you’ve been doing this job… Here it comes… Hey there is a public toilet coming up on the left – go on, ask your partner to pull over.. I dare you.

Rob: I just might do that, if this traffic gets any heavier.

Rob’s Bladder: And how do you intend to get away with that? Little Jimmy’s mother already thinks you look edgy and nervous. Now you want to stop on the side of the road and run into a dodgy looking public toilet while her little baby is in so much pain – you selfish monster. Hey look, that guy is watering his lawn – with a hose…

Rob: …we’re almost at the hospital. I’m going to make it, then we’ll hear no more of your crap.

Rob’s Bladder: Crap? You really wanna go there? One word from me and the fellas who are looking after that Thai curry you ate last night could be working overtime..

Rob: (Groan) ……………

Rob’s Bladder: Oooh Look, we’re at hospital, but alas! There are 3 ambulances ahead of us, and that really slooow nurse is at the triage desk – oh boy this is going to be funny. “Can I have a mop and bucket to the Emergency department”. Heh heh…Wait ‘til I tell the lads in the kidneys about this…

Ambulance crisis

A recent comment by Altissima said...

Rob, I would be interested to hear your response to the article that appeared in Sunday's Age:
Ambulance crisis as 'killer' shifts take toll.
MELBOURNE is losing some of its most highly trained and experienced ambulance paramedics because of what they say is a dangerously heavy workload, an inflexible "killer" roster and a dispatch system that sends them to inappropriate "nonsense" cases...
Full article can be found here: http://tinyurl.com/y7czbv

Firstly thanks Altissima for bringing that to my attention. I missed the article when it was run. Look for what my response is worth, I'd have to say that the article is a fairly accurate reflection of the feeling of paramedics on the road at the moment, whether they are MICA paramedics or not. Everyone is working really hard right now and many are suffering both personally and or professionally because of it.

The current workload appears to be increased - why? Many think its because of the recently introduced Nurse On Call service which seems to be flooding us with jobs, the majority of which turn out to not need an ambulance. Whether this is also due to the Nurse On Call staff being hesitant to tell people to see their own doctor in the morning. I was told that when the same kind of service was introduced in the UK there was an initial increase in calls but then it reduced the overall call rate - Please someone over there let me know if that is the case, or have we been fed a big serving of PR. Other reasons? There are many, the dispatch grid, the rostering, the public perception of what constitutes an emergency. These are problems being experienced by ambulance services worldwide.

As far as the MICA officers leaving, yes there have been a considerable number of them leave, and this represents an enormous loss of skills and experience for the service and the general public. While many of the standard Paramedic units have alternate rosters, with or without nightshifts that they can arrange to spend time on if they get exhausted, the MICA crews only have the 10/14 roster. And when our grid system has them running around, chasing their tails and going to crazy jobs, its no wonder that many have thrown in the towel. All of us, MICA or not are expected to remain motivated and perform at our highest standards at all times. This is a hard thing to do when you are completely trashed.

The dispatch grid is directly repsonsive to the data that is fed into it - that's what it was designed for. However if you ask the relative of the person who has a nasty cough and a chest cold; is the patient breathing normally? the answer will inevitably come back that no they aren't. Do they have chest pain? Again the answer is likely to be Yes. They are in pain when they cough. This automatically gets a lights and sirens response because its now coded as Chest pain with abnormal breathing. If the Clinician who is on duty happens to have a look at it and catch it before it goes out, the case may get downgraded. But otherwise 2 cars are now barrelling through the streets trying to get there inside the allocated time frame.

As far as nonsense dispatches, I have personally been sent twice in the last month to people who can't sleep, to other people who have an outpatient appointment at the hospital in the morning and thought they'd save the taxi fare, people who left the waiting room at the hospital and went home to call an ambulance, thinking they'd get seen quicker if they come in by ambulance. Ask any paramedic and they'll tell you a long list of unbelievable things people have called an ambulance for. Solve that issue and you'd go a long way to relieving the workload.

How refreshing

Signal 1 call to a suburban doctor's surgery for "chest pain". Found the patient in a quiet room, with somebody looking after him, on oxygen, a 12 lead ECG completed, cannulated with pain relief and nitrates being given. And to cap it all off, there was a doctor in attendance who was calm, gave a good handover and didn't appear impatient to go running off to attend to the crowd in the waiting room. I was stunned.

Sigh, so young and so jaded already....

This really restored my faith that there actually are some quality doctors out there who are working in their patient's best interests. I mean of course they are out there, but we so often seem to go to the dud ones. Anyway, I was chuffed and thanked the doc repeatedly. Maybe I overdid it, but if she thought I was a tool, she did a good job of hiding it.

A real winner

We met a deadset winner today. A hero. A legend. The kind of guy any of us would love to have as a neighbour. After drinking biblical amounts of Woodstock cans all day - oh for those who aren't familiar with this particular special brand of pre-mixed spirits in a can, all I can say is get out there buy yourself a box of 'em and sit there on a plastic milk crate drinking the lot until you too become a champion. Tip: You can also use some of the cardboard carton to make the overturned milk crate more comfortable to sit on.

Anyway, I digress. Our winner soon started a verbal debate with the neighbours and then when he'd drunk enough to put Mikhail Gorbachev on his ear, he jumped in his car to drive up and down, and up and down the street showing his prowess at doing burnouts. The tyres eventually flamed out and he crashed into a fence - it had nothing to do with his well-hidden and unsung talents as a racing car driver, I guess there must have been some oil on the road.

Not yet done, he then started a fight with the people whose fence he'd hit. But true heroes don't give up that easily. Our champion also suddenly announced that he was a martial arts expert and wanted to demonstrate his talents on the police when they arrived. He got rugby-tackled and a lovely set of steel bracelets for his efforts. Finally he abused and spat at all the emergency services people who came to sort out the mess, demanding a victory cigarette from anyone in earshot. If I was a winner like him, I would probably want my victory cigarette too.

As he was chauffeur driven away in the back of the Police van I was buoyed by the fact he was still calling out to his fans and giving us directions. I thought it was a nice gesture that even though he was a hero, he hadn't forgotten about us, the little people. The wannabe heroes.

The startle reflex

I was lying on the couch at about 4am this morning. It was peaceful at the branch except for the faint white noise from the air-conditioner. Anyway, I got to thinking about how we get so used to seeing bizarre stuff, so overstimulated, that if someone’s head opened up in the back of an ambulance and the Queen floated out riding a bicycle, we’d probably not bat an eyelid and instead write it down on the case sheet in that matter-of-fact way; “04:02 am: Patient’s head spontaneously opened revealing small Royal figure on 2 wheeled vehicle. Patient displaying no apparent ill effects”.

On the one hand we are desensitised by the job, and not easily surprised - and on the other hand the slightest beep from a mobile phone, an MDT or a SelCall and your heart is racing and you are wide awake (mostly). I was recently standing behind someone in the post office when their pager went off and it had the same physical reaction on me as if I was at work. That constant stimulation of the fight-or-flight reflex just can’t be good for you.

Actually I just remembered about the rather enthusiastic young ambulance student who turned up at the branch with an Ambulance siren as the ringtone on her mobile phone. By lunchtime on her first day I think someone quietly took her aside and made some suggestions, before she was lynched by the crews at branch.

Dominos

I work in the city, so incidents involving livestock are pretty rare. When we got dispatched to an old man with a suspected broken leg following a fall, I thought it would be fairly straightforward. We were greeted by his wife and daughter and led to where the man was lying on the couch at home. As we walked down the hall I asked what was happening today – sometimes you can get a few quick details from family members as they take you to the patient. His daughter just said he speaks mostly Italian, but she would let him tell the story. For a moment I thought she appeared to by trying to stifle a laugh, but I dismissed it as I walked into the back room.

Our patient was a fit looking older fellow with a thick accent, but his English was substantially better than my Italian. He was smiling and greeted us warmly when we walked in. I asked what had happened and he said “well…” and the vigorous arm waving began, “well…you know that bloody cow?”. For a second I was worried he was talking about his wife who was hovering nearby. His daughter must have seen the look on my face and began explaining that her father and mother had a small farm on the outskirts of Melbourne and both had been up there today fixing a fence. I asked again what had happened and was told by our patient that he had been working on the fence when ‘that bloody cow’ had stepped sideways and bumped into him. “Ah and that’s how you hurt your leg?” “No” all three of them replied almost at once. “The cow… he hit me..and... I hit the sheeps” Lots more gesticulating. Hmmm. I needed clarification.

I turned to his daughter who by this stage was unable to contain herself and told me the full story. Her dad had been knocked sideways by a cow he owns, who it seems sort-of nuzzles up against people, and he had then fallen over one of the sheep who was also crowding round thinking it was going to get fed. Her father had gone down in a heap on the ground injuring his leg. While we assessed him, I asked a few more questions. “So your wife then drove you home and you rang an ambulance?”, “No she is no good driver, I drive”. “You drove?!”. It turned out the farm was over an hour away - a long way with a broken leg.

I enquired about his pain level, and he waved me away dismissively saying he was alright. I looked at the increased heart rate on the monitor and the beads of sweat on his forehead and decided to try and make him a bit more settled. He had a probable fractured leg that would make most of us weep and he was being stoic. Tough old bugger. When he was loaded up in the ambulance and away from his family I again offered him some pain relief – I was glad he agreed and was soon a bit more comfortable. I joked with him on the way to hospital; “So what are you having for dinner tonight – the cow or the sheep?” He just said; “Pasta, she always make pasta”.

Now I lay me down to sleep

Hey firstly thanks for all the great comments lately everyone, you have made me laugh several times!

I've just completed a Saturday nightshift. My eyes are burning and I feel slightly nauseous from lack of sleep and too much coffee. It was a flat out night, 15 hours with just a 30 minute break early in the night where I managed to grab a meal. I was lucky, I heard many of the cars still reporting they had not eaten a meal late into the night. The city hospitals were struggling and the ambulance service was running around all night, chasing all sorts of calls until the morning finally arrived and it died off a bit. There are a lot of very tired paramedics out there this morning.

My partner and I did no really major jobs of note, just an assortment of miscellaneous calls - a regular caller who is a chronic alcoholic and has taken to ringing for the most rediculous reasons, an old girl in a nursing home with a fever, a drunk young man with laceration to the leg, a man with angina, a man who had been assaulted the day before and now had two black eyes, a woman with anxiety, another woman hyperventilating, a man with abdo pain and a girl with a sore throat, oh and a kid who had fallen out of a high chair.

All in all a big night. But now I am bone tired and need to sleep. I have a few good stories to tell but they will have to wait until I'm rested. Eyes are getting heavy...

Let the snoring begin.

Give me strength

Patient: Me foot hurts

Rob: How long have you had the plaster cast on it?

Patient: Free days

Rob: You broke your ankle?

Patient: Um.. I fink so.

Rob: ...you think so?

Patient: Mate I don’t know – I don’ remember.

Rob: Have you been taking any pain relief medication for it?

Patient: Nah.

Rob: Any reason why not?

Patient: I haven’t got the script filled yet.

Rob: er...why not?

Patient: I dunno.

Rob: Has it been hurting since you broke it?

Patient: Yeah but it’s been getting worser.

Rob: Have you been walking on it?

Patient: Nuh

Rob: The bottom of the cast is pretty black and worn out, are you sure you haven’t been walking on it?

At this point Rob’s partner holds up a cigarette butt he’s just found stuck to the base of the patient’s plaster cast

Patient: Just down to the shops an’ that.

Rob: (Sigh)

Patient: It hurts

Rob: So you broke it 3 days ago, have been walking around on it and now it’s sore?

Patient: Yeah

Rob (getting frustrated): Any reason you didn’t get your prescription filled when you went down to the shops?

Patient: Um…I didn’t think about that...

Rob’s partner (getting frustrated): …but wasn’t your foot hurting?

Patient (getting frustrated): Yeah. Look mate, I wanna go to hospital.

Patient then walked out to the ambulance

Chomolungma

It’s funny the conversations you have in the wee small hours of the morning. Driving back from hospital along the freeway with my work partner we’ll sometimes find ourselves talking about the most bizarre things. Last night we discussed wind farms, the mighty Pavlova, roof guttering, ….oh and the guy who’d just tried to chop his man bits off with a knife because his previous attempt at dropping a television on it hadn’t quite achieved what he was after.

If you are confused by that, you are not alone. When the crew who just brought him to hospital told me the story, I had nothing but questions. Lots and lots of questions. The main one was why? But I have no answers for you, sorry.

Like me you will just have to settle for the Mount Everest explanation: Because it’s there.

Shakes on a plane

We went to the airport again and got to go on a very big shiny plane. I love it. We drive out onto the tarmac and the planes seem so much larger when you park beneath them. It’s windy, cold and very loud. The unmistakeable smell of jet fuel is carried on the wind. We head inside and up some stairs to the gate lounge. It’s so much quieter inside. A pack of us stand there silently waiting for the plane to taxi to the gate. The airport people, the airline staff, the customs people, the quarantine officers and a couple of paramedics with their bags – all with their jobs to do, all looking pale and sickly under the fluoro lights of the gangway.

The plane door eventually opens up. The well-tanned flight attendants say good evening and still manage to smile even though I know they have probably been doing it through gritted teeth since they left LA, Singapore or Dubai or wherever it is they have come from. The flight staff tell us they will wait for our all clear before moving people off. We walk on past business class, into the cabin and 200 faces look up. The quarantine people are anxiously waiting for us to tell them that we don’t think its something nasty like SARS or Bird Flu. Who knows what they’d do if we thought it was – perhaps tow us back out to the middle of the runway and leave us there to fend for ourselves…

I work my way down the rows towards row 26, bumping my bags into chairs, people and fittings. Sorry…excuse me…Row 22, 23, 24…..its going to be a window seat. It always is. People are standing in the gaps between the rows, cabin luggage in hand, anxious to get off. A young girl is curled up against the window with her knees drawn up. She peers out from under her hair and I can see she’s been crying. I ask the person holding her hand to move out and talk to my partner while I slide in to the seat next to her. At least I can say I sat on a plane even if I didn’t actually get to fly anywhere. For a brief moment I realise how much I’d like to be flying back from somewhere warm.

The girl’s English is poor and I take a second to understand her accent and sentence structure. It’s weird like that, I find you sort-of ‘tune in’ to the way people talk. I can overhear my partner talking to the crew and she’s being told; “…the girl was shaking violently during the flight…they though it was a seizure….is she going to be ok?...we gave her some oxygen”. I do a bit more of an assessment and see that the girl is still trembling. I can see she seems in no immediate danger and I give the flight attendant the go ahead to move everyone off the plane. We don’t need to get off in a hurry and in a few minutes it will be a lot calmer and quieter in the cabin. The quarantine person taps me on the shoulder anxious for my opinion. I quietly relay to him that I think it might be an anxiety issue. He seems happy with that and goes away writing something on a clipboard. The people begin to file off the plane and I notice with some amusement that the same rubbernecking behaviour we see with car crashes happens as the passengers shuffle past us down the aisles.

The girl turns out to be older than she looks and is travelling with her parents who speak no English at all – we struggle to find out much information from them. I turn back to the girl and she has begun to violently shake again. I can see why the flight attendants were a bit freaked out. She’s shaking, but it is clearly not a seizure. I hold her hand and get right in her face while we talk. She calms down a bit. The plane empties and we walk her a few steps to where my partner has a wheelchair waiting. I watch the parents as we walk out and see that they are not looking quite as concerned as I would expect – I figure they have seen this before. I give them a reassuring smile but it seems to have little effect.

We head down in the lift to ambulance and all climb in. I start my assessment again from the top. I want to be sure I haven’t missed anything. She starts breathing heavily and the shakes begin again. I catch my partner’s gaze in the rear-view mirror. She looks puzzled – so am I. It looks like an anxiety type episode, but with very little dialogue between any of us, it’s hard to tell. We follow the escort car as it leads us out to the airport gate. The driver waves us on and I hear my partner call out “thankyou” even though the escort guy can’t hear us.

Soon we are on the freeway heading for hospital, me holding the hand of a distressed girl, her mother staring at me expressionless, her dad up front sitting silently as my partner guides us towards the city. I can’t help but wonder what they are all thinking.

Service interruption

Guys and girls, sorry no posts for a while - I've been off work and off the air looking after a close relative who is unwell. Normal programming will resume ASAHP. Please bear with me.

Thanks,

Rob

Soundtrack

Quite some time ago "they" (those people who do stuff when I'm on days off) took away our music, by this I mean they disabled and disconnected the CD players in all the ambulances. For a while there we were able to go screaming through the streets with Wagner's Ride of the Valkyries (from the Apocalypse Now soundtrack) blasting from the stereo as we made our approach. Occasionally in our haste to get out of the truck at a job, we'd leave the volume turned up. When we had just got grandpa settled on the bed in the back, and we've helped nanna finally get her seatbelt on in the front, we'd start up the truck and scare the absolute crap out of everybody. I can't imagine why did they took them away.

Now we just have the radio which is wired through the data terminal (MDT) in the truck and has atrocious reception - if you like your Britney Spears with a lot of hiss and crackle (which I actually do) then its fine, but if you really want to hear the cricket score or the traffic report - Tough. A few of us now bring in iPods and transmit through the radio - it still sounds crappy but it does give us a way to listen to something other than moronic talkback at 4 am.

Today I've been making up a playlist to play in the ambulance. I figure I need a good mix of tunes from a variety of artists. I hope I have something for everybody :)

Kanje West - Breathe in Breathe out
Audiovent - I cant breathe
The Police - Every breath you take
Yes - Saving my Heart
NOFX - You're Bleeding
The Replacements - Take me down to the hospital
Bob Dylan - It's Alright, Ma (I'm Only Bleeding)
Boy George - Do You Really Want To Hurt Me
Urge Overkill - Positive Bleeding
Metallica - Kill em all
The Flaming Lips - Mr. Ambulance Driver
Bon Jovi's - Bad medicine
Tori Amos - Taxi Ride
Lynyrd Skynyrd - That Smell
Pearl Jam - Let Me Sleep
The Prodigy - Crazy man
Queens Of The Stone Age - Everybody Knows That You Are Insane
Madness - House of Fun
Mark Knopfler - Don't Crash The Ambulance
Madness - Cardiac Arrest
Golden Boy - Rippin' Kitten ( I feel like takin' a life)
Nat King Cole - Pick Yourself Up
Led Zeppelin - Sick Again
Pink - You Make Me Sick
Blur - Ambulance
Eskimo Joe - I'm So Tired
Alkaline Trio - My Little Needle
Guttermouth - This Won't Hurt A Bit
and lastly..
Frank Zappa - Why Does It Hurt When I Pee?

Well, That oughtta just about do it. Anybody have any others I can add?

Burned

I've hung onto this story for about a week, not sure if I would post it - but I'll relate it here because it highlights how vulnerable our elderly can be. I think its just about the worst ambulance story I have ever heard. By that I mean the most tragic, horrible and ultimately sad.

I got this story directly from the crew who attended this case last week, so I hope I can keep to the basic facts.

An elderly woman spills something from her stove (probably oil) onto her legs and is engulfed in flames from the thighs down. She attempts to put the flames out with her hands but is unable to. She knows that she is supposed to push the button on the medi-alert pendant round her neck if "something happens", so she pushes it and sits down in a chair. The alert company contacts her on speaker phone and hear her desperately crying out for help. They call for an ambulance. Another nearby person (who I think was a council worker, but I may be wrong) is also notified. He arrives at the house after about 5 minutes, gains entry and finds the woman still on fire. He extinguishes the flames and shortly after this the first ambulance arrives. The crew apply burns dressings to her legs, but there is little point. The woman has effectively burned all the soft tissue away from her legs from the thigh to the ankles. Not much more than bone remains. She is still conscious. A MICA unit is soon on scene and the woman is conveyed to hospital.

The crew later told me they believed she would die in the few days after arriving at hospital.

Many elderly people will stubbornly (and quite understandably) fight to stay living at home, preferring their independence, often long after it is safe for them to do so. Please if you have elderly neighbours, keep an eye on them and maybe drop in and make sure they are ok every now and then.

Nil by mouth

Normally I bring in my meals on nightshift, that way when I do finally get a break I am not scrounging around the kebab joints and taxi cafes at 3 am looking for something edible, something that will not kill me before the end of the shift. Yesterday we could not get a feed to save ourselves. In the end it became comical. We would walk into a place and before we had even settled on something on the menu - the pager would go off and we would be walking back to the truck...cursing.

Each time we walked in to place serving food we would get a SelCall for a job. The sandwich place was bringing in its tables as we pulled up. The pasta place was flat out and after queuing for whileI gave up. Later I ordered a pizza and cancelled it before it had been put in the oven. Later still I ordered a kebab and then suffered a vicious scowl from the guy behind the counter, despite cheerily saying we'll be back soon. We wouldn't and we weren't. I started looking around to see if we were being filmed for some kind of Candid Camera show - ha ha really funny guys - its midnight and I'm about ready to eat a box of rubber gloves from the truck.

We finally pulled into a service station and I stood there for a bit almost tempted to go one of those pre-packaged bacteria-filled certain-death chicken sandwiches. Normally I wouldn't even consider eating something like this, but my Blood Sugar Level had dropped to well below my mental age and these little guys had the crusts cut off them and all. Fortunately the little voice in my ear that was telling me not to buy them, won out. I guess that's why we work in pairs after all. A bag of peanuts, a fruit juice and a deranged psych patient later we got back to branch. I ate about seven pieces of toast with every different topping I could find in the cupboard. Bless the social club for keeping us well stocked. Exhausted but finally sated, I fell asleep on the couch watching infomercials.

The disappearing patient

Dispatched to a shooting in the suburbs late in the afternoon. A dual car response with a MICA unit backing us. We were told to exercise due caution and not approach the scene until it was declared safe by the police. Fair call - I am no hero and I am more than happy to wait til things have settled down a bit - specially if there are high velocity weapons involved. The police gave us a location in the next street where thay wanted us to wait. Our patient had apprently been shot at home and the caller was stating the whereabouts of the offender was unknown. We waited and listened intently to the radio, knowing full well lots of other ambulance crews would be doing the same - everyone listens to events like this when they happen - and it can be very compelling listening.

Shortly after we arrived at our staging area, we got an update through saying that police had entered the scene and someone had indeed been shot. Then a minute later another update stating the patient was now no-longer breathing. However the area was still not secure and we were instructed to wait where we were. Oooh, we thought, this was for real. We were discussing that with the delay in accessing the patient and a gunshot wound that stops you breathing, the victim was probably "very irreversibly unwell".

The next few minutes seemed to take for ever as we waited for news. Finally the dispatcher came up on the radio and said we could cancel(!). The police had just advised that there was no patient. What the...?! I'm still at a loss as to how a job goes from confirmed gunshot wounds and not breathing to 'move along thanks, nothing to see here'. Abducted by aliens? Witness protection? You tell me.

Dame Edna

Many of us who work in the northern suburbs have met Dame Edna. Now I should immediately point out that despite appearences, this is not the real Dame Edna. She/he is a familiar sight at a certain hospital and many of us have picked her/him up. Edna is a colourful character both literally and figuratively speaking who doesn't seem to mind ambos, but really doesn't like hospital staff. So he/she can be nice as pie on the way to hospital and then drives the ED staff mad for the rest of the day. I might have him for twenty minutes. They can have him for their whole shift.

The first time I picked up Dame Edna I was a little shocked. Here was a six foot hairy man (woman?) wearing a dress, the purple wig, stylin' glasses, waving a glowing plastic flower in one hand and a fag in the other. Rumor also has it that he tried several other personas, including a certain superhero before finding "the One". Edna has a nasty tendency to take a lot of a close relatives medication resulting in the need to go to hospital for observation.

Last time we picked her up, she (yeah, I'll just say she, it's easier) ... she had absconded from hospital before they could monitor her blood levels. My partner was a little stunned when she charged out of the house towards us. Fortunately the Dame was in a reasonable mood. We dropped her off, they took blood samples and she had stormed out in a rage, waving her flower and scaring the entire waiting room to death long before I had finished my case notes.

A day in the life

I have just finished watching an online video of pieces of the Eiger crumbling into a swiss valley. Almost immediately I noticed some parallels with the week I just had. It got me thinking about what I thought this job would be.... before I knew anything about it.

When I first applied for 'the job' I was asked as part of my application to write a piece entitled "A day in the life of a paramedic". This was all well and good, but I wasn't a paramedic and really if I took any time to think about it I had no idea what a paramedic's day was like. I had a pen in my hand and a mere 30 minutes to convey that I could:

• string a sentence together
• sho tha' I cood spel good e'nuf
• write all about a day that I knew nothing about... yet.

I remember I ended up writing a rather poor attempt at a humorous day on the ambulance where I locked the keys in the truck. I would love to go back and read that piece now - I think I would find myself laughing at how naive I was. It has probably long been shredded by the recruitment division - although its possible it is being held in my file as evidence that I never really had a clue! So to finally set the record straight, here is a day in the life:

06:32 am
Slide my key into the lock at branch. I'm trying to be quiet and not wake the nightshift in case they are asleep. I do this in spite of the fact I know they love to hear the sound of the dayshift arriving to take over the truck. I know I do the same. A couple of sleepy heads look up at me, say good morning and stretch. I ask how the night was and learn that they got back to branch about 5.30 and have so-far not had the late call out. I hear the stories from the night - inevitably they only talk about the 'bigger' jobs or the more ridiculous call outs at 2 am. All in all it sounds like a normal night where I work. I go and make a cuppa. My partner won't be far behind me.

06:45 am
We head out and check the truck. Make sure the nightshift haven't left any of their personal gear on in the cab and make sure we have the right amount of drugs, Cx collars, Oxygen, bandages, IV gear, Airsplints, Emesis bags etc. We make sure that the suction is working, the defibrillator batteries test ok, the OxySaver circuit doesn't leak, the flashing lights flash, and the siren works. We restock a few things, hang our raincoats behind our seats and log in to the MDT as day shift. The truck is dirty outside and in from the wet night before, so we give it a quick mop and change the bins inside the cab. I pledge to wash the outside later in the day.

07.10 am
The nightshift crew are now awake enough to go home. We wish them a good sleep. They'll be back in a few hours to relieve us at the end of our shift. I put the kettle on again.

07:12 am
The SelCall goes off and we are dispatched to a car accident on the freeway. Single car, Code 1 thanks. Its dispatched as 'inbound' near a particular exit. This road always gives us trouble because it doesn't actually go into the city but instead circles some of the outer suburbs. So there is always discussion about what constitutes 'inbound'. Calling it Eastbound or Westbound usually doesn't help either because at various times this road is oriented to almost every point of the compass. We head for the truck and come up on air to ask for clarification. Its a long burn through morning traffic, dodging and weaving until we reach the freeway. We finally locate two vehicles that have had a low speed merging accident. There are plenty of tears but no injuries. We collect details, offer reassurance, transport and wait for relatives, police and tow trucks to arrive. Nobody wants to go to hospital.

07:59 am
Case notes completed, we head back through the morning traffic towards branch. We hear another nearby car get diverted from a low priority case to an urgent Signal 1 job. We know our area pretty well and can predict that we'll now get the job they got diverted from. Sure enough. We're soon sent to a nursing home to assess and transport an elderly man with high blood pressure and fever. Its one of the better nursing homes in the area and the old fella turns out to be quite a live wire. We have a few good laughs as we take him into a city hospital.

09:40 am
Stop off and grab a coffee and a muffin from our favourite place on the way back to branch. We're backing the car into the garage when the MDT pings again. We're now backing one of the MICA crews to a 5 year old, Severe shortness of breath, Asthma History case nearby. We arrive and find one of the MICA guys loading his bags back into the truck. He says his partner is just finishing up inside and we won't be needed. His partner comes out of the house shaking her head. Nobody is short of breath here. They thank us for coming and we mark ourselves clear on the MDT and ready for the next case.

10:17 am
New case, 54 year old male, back pain, non recent, non traumatic, Signal 2 thanks. This guy has a known injury from work, he's seen his own doctor, he's been taking his pain relief but he's still clearly in a lot of pain. He lives alone and can't drive himself to hospital. We load him up, give him some pain relief and take him to the nearest hospital. We follow up on one of my patients from the day before and find out he's gone home already - inconclusive diagnosis.

11:35 am
Back at branch for lunch, I stick my food in the microwave and push the buttons, the SelCall goes off immediately. Crap. We quickly pack away our food and head for the truck. 82 year old female, Uncontrolled Epistaxis, Signal 1. I know the nursing home we are going to and don't need to look up the address. We arrive and are led to a small room where a staff member is holding a blood-soaked towel under the nose of a frightened looking old woman. I ask to have a look and see that the blood is actively pouring out of both nostrils. My partner applies pinch pressure to the woman's nose while I check her vital signs. We head for hospital with me holding her nose the whole way. My arm aches and I feel like I have been glued to her for ages.

13.09
We finally get to eat lunch. Another crew drops in and we talk for a while before they get a job out at the airport.

13.48
My partner and I swap jobs, Its now my turn to drive for the afternoon. The Selcall beeps again. The dispatcher starts her conversation with "A bit of a drive for you". and gives us a Signal 3 transport job way out on the edge of the city. There are cows and tractors and rolling hills. Its a long drive but the scenery is good and we chat about non ambulance stuff. For a while we could be two people going for a leisurely drive in the country. Then we arrive and find the farm where our patient is waiting at the gate with bags packed. We drive him back to the hospital where we took the bloke with back pain earlier in the morning. I wave as we walk past his cubicle. He now looks a lot more comfortable and I'm glad to see a couple of his mates have called in to visit.

15.21
On the way back from hospital we are flagged down by a person on the street. An old lady has had a fainting episode in the post office. We stop, tell the dispatcher what has happened and they create what is called a field event for us. We head in and assess her. She's pale but alert and we suggest she comes up to hospital. She has a Gold Card, meaning she's probably a war widow, so we can take her to one of the private hospitals nearby. She's a nice old chook and the staff remember her from last time she was in.

16.04
We clear the hospital and get dispatched almost immediately to a child that has fallen from some play equipment and is now in an altered conscious state. The traffic is already building for the evening rush and I have to work hard to get through. On the way, the dispatcher calls us up and tells us we can cancel for a closer car, this means some other crew has just become available and will get there sooner. We flick off the beacons and siren and slow down to join the stream of cars heading out of the city. We stop and refuel the truck, ready for the nightshift.

16.37
We arrive back at branch, restock a few things and the nightshift crew are just arriving. I gladly hand over the keys and the portable radio. They ask how the day has been. We pack up and head home, we'll be back for nightshift tomorrow night. I never did get to wash the truck.

But its just Paracetamol

In the past 2 days I have been to 3 deliberate Paracetamol overdoses. These people had each taken between 50 and 300 paracetamol tablets. They all were trying to get the attention of somebody; a girlfriend, a husband, a son whoever. I am convinced that not one of these people actually wanted to die. I’m also sure it all seemed like a good idea at the time. Paracetamol is commonly ingested in the mistaken belief that it is a “safe” drug to overdose on. Its readily available, it’s cheap and it doesn’t do any harm. Right? Wrong.

Overdosing on Paracetamol damages your liver. It won’t kill you right away but you can expect several increasingly miserable days before you succumb to its effects. There is a very narrow window of time in which the available treatment for Paracetamol overdose is effective. Unfortunately 2 of the three cases I attended had missed this window by many, many hours and it is now just a case of waiting to see how much liver damage has occurred and whether it is going to be fatal. I really doubt this was what these people had in mind when they reached for the packet.

Today I found myself standing at hospital, counting empty blister packs from common household pain relief medications and listening to a distrught teenager hearing the bad news from a doctor about what she had actually done. A big dose of cold, hard reality. You can be sure that argument she had with her boyfriend last night was suddenly seeming pretty trivial.

EDIT: September 2011 - this particular post for some reason is getting a lot of hits from all over the world. Having read a lot of the search terms being used to find this post, I have great concerns that what is written here must give the right message. If you or someone you know is considering harming themselves, pick up the phone, talk to somebody, get some help. Please.

Walk slow, like a fish

We were crawling along in peak hour traffic, trying to get back to branch so we could go home. We were already nearly an hour past our scheduled knock off time. My partner and I both had dinner arrangements to go to, so we were starting to get edgy. It seemed like everybody else had the same idea as the hoards streamed out of the city. You quickly learn not to make plans to do anything immediately after your shift – inevitably it will be the night when you get a late job.

We had almost made it to the start of the freeway when the traffic ground to a complete halt. We were doomed. Any second now we would be the closest car to something…We could almost feel it coming... Bamm!!!! The MDT (mobile data terminal) let out the noise. “Sorry about the timing guys but you are the closest car”. I pushed the acknowledge button and reached for the street directory. Sure enough, we were almost on top of the job. Signal 1, conscious overdose. My partner flicked on the beacons and siren and she edged us out of the evening gridlock to do a U-turn and head back towards the city – we were both going to be late for dinner.

The police were also attending the same case as the patient was known to have a history of aggression towards emergency services when she was intoxicated. She answered the door and it was immediately apparent she was drunk. “Hello darlings” she boomed at us in a voice that was just slightly louder than normal limits. Our patient was a woman of about 50 with wild looking hair and very few teeth. She also had a very thick eastern European accent. While I did an assessment and got a bit of a story my partner and the police searched her house for the tablets and alcohol she claimed she had taken. It turned out to be very little and probably not enough to make her more than a little drowsy – however it was her intent that we had to take seriously. So I told her she would be getting a trip up to hospital. At this she brightened up considerably and started telling me that it would be good to get out of the house because people had been looking in her windows and watching her lately. She fluctuated between cheerful and distressed while I spoke to her. Clearly she needed some assistance.

As we walked down to the ambulance, she kept apologising: “darling sorry I walk so slow… but always my ribs hurt”. I asked her why and was told she’d had an accident many years ago. Then she said “its ok, I just walk slow.. like a fish”. That made my night. It was such a good visual image, I was chuckling all the way to hospital. We all hopped into the truck, said thanks and goodbye to the police and moved off. While I wrote up my case notes I saw she was staring at my blue ambulance gloves, so I gave her a pair. Her face lit up and she wore them all the way to hospital. The last I saw of her she was sitting up in bed in a hospital cubical waving a blue hand at me with a big toothless grin. I could still hear her shouting ‘Tank you darling” as I headed out to the truck, eager to get home and walking nothing at all like a fish.

Crew Safety

A few nights ago some of my colleagues attended building where a girl had fallen from a balcony and landed a few floors down on another one. She was very badly hurt. When they arrived they were set upon by several people at the scene. The news story is here. Although I personally don't know the crews involved very well, I have met them enough to know they are not gung-ho types who would walk in being in any way confrontational. These people were good ambos trying to do their job helping someone who was critically injured and they were assaulted by 'friends' of the patient who were upset she wasn't being treated. It just doesn't make any sense. Their behaviour actually delayed access to their friend and thereby seriously delayed treatment.

In 2004, the Victorian State Government introduced legislation to protect paramedics responding to emergency calls. This was following public outcry after a horrendous attack by several people on two of our experienced paramedics attending a case, resulting in very serious injuries. The amendments made to the Ambulance Services Act and the Summary Offences Act mean paramedics have the same type of legal protection from attack as police officer. Any person who attacks or harasses a paramedic in the course of their duty can face a fine of up to $6000 and six months jail. But this is just legal protection. This incident shows it is clearly not much of a deterrant. How sad and pathetic that we even need to have laws like these in place.

Burnin' down the house

A couple of years ago we got dispatched to standby at a shop fire in a busy shopping strip. We usually get called because there is the possibility that the men and women of the fire services might get injured while dealing with the fire, but occasionally someone else is affected by smoke or flames. This particular fire was quite substantial and well alight when crews got there. If I remember correctly somebody had made good on their threat to burn the place to the ground over a property dispute. We were asked to standby a little way down the street and out front of a small coffee shop. Sadly we had to sit there for almost 2 hours, drinking cappucinos, eating fresh sandwiches and watching the show. Terrible stuff ;)

Recently my learned colleague and I were dispatched to standby at a house fire in a suburban street. We couldn't see much smoke as we drove towards the scene so we thought it might be a false alarm. When we arrived the house was still smoldering (fire savvy people may know the right terminology), the flames were out but smoke and steam was still pouring out the roof, windows and doors. We could clearly see the place was destroyed. We found the fire commander on scene and let him know we were there if he needed us. He told us the crews were putting on their BA's to go in and search the house for any occupants and that once that was done we could clear and head back to branch. Sadly there were no coffee shops in sight this time.

While we waited around we were told by the police on scene that the owner of the house had been contacted and told that his house had burnt down. Apparently he was rather nonplussed and was declining to come home from work to check it out. I don't know about you, but I'd probably want to get home and have a look. Fortunately nobody was hurt and we were eventually released from the scene. I went home and checked the batteries in my smoke detectors.

Parenting Permit?

Yesterday while driving our ambulance around and looking for trouble, we pulled up next to a fairly new looking car at some traffic lights, two adults in the front and one clearly unrestrained kid of about 3 standing on the back seat looking back seat at us. Being a complete do-gooder, smart-ass, know-it-all, who really can't mind his own business, I wound down the window to politely suggest that a seatbelt and maybe a booster seat would be a good option for the little guy in the back seat. Thats when I noticed another smaller child sitting on mum's lap in the front seat. No it wasn't Britany Spears, sorry. I could see from my high moral standpoint, or as I prefer to call it; the elevated cab of the ambulance, that both mum and child were completely unrestrained too.

Well boy was I set back on the right path - what was I thinking by trying to impose my snooty value judgements on these fine parents? I was given a right royal serving and told to go elsewhere. I was chastened yes, but still I hadn't quite learned my lesson and figured I let the Police deal with it.... 'cause although I had a uniform and some flashing lights and stuff, I was apparently a "wanna-be cop who can't mind his own business". Despite an afternoon phone call to the police, I was outsmarted once again because the vehicle was not even registered.

Just another code 3

Recently we got dispatched to do a routine code 3 transport. We get to do these when the private company that has the contract to handle these jobs is too busy or is “unable to meet the timeframe” – this seems to happen quite a lot. Normally this means the patient needs to get to dialysis or some other appointment and does not need an emergency ambulance. This particular patient was scheduled by her doctor to go and have a CT scan due to a week of severe headaches. We are usually required to be there within an hour of dispatch – this means you can at least finish your cuppa at branch and don’t exactly need to run to the truck :)

On arrival my partner and I were met at the door by the patient’s husband (who only spoke a little English) who led us to the lounge room where we walked in to find a young woman sitting on a couch, wearing a nightie and being supported by some other family members. I introduced myself and got no response from the woman; she didn’t meet my gaze and just stared off into the distance vacantly. I asked her husband what had been happening today - I already knew we had been called to take her down to her appointment but I wanted to find out a little more. After a long and unproductive attempt at conversation involving several elderly family members I finally resorted to conversing only with the primary school age child who was there. She was able to give me really good yes and no answers – kids are great like that.

It turns out that this woman had indeed had a history of headaches and vomiting for about a week and her doctor had decided it was time to do a scan to try and rule out anything sinister like a tumour or a bleed of some kind. She’d had a baby about 4 months ago and had been in good health since. However she’d been completely non-conversant since getting out of bed in the morning and had been found standing in the kitchen “with her eyes going all crazy” or just sitting on the couch staring like she was now. My partner and I both looked at each other realising that this woman was possibly quite unwell and we would be taking her to an emergency department and not to her appointment. I tried to assess her but she would get really irritated and resistive, letting out some horrible guttural screams whenever she was touched by anybody. I was beginning to think she had possibly had a cerebral event of some sort – that might fit with the recent history of headaches. She appeared to have full use of her arms and legs when pushing me away and there was no obvious facial droop – so the classic stroke symptoms weren’t there. That of course did not rule out anything. As we loaded her into the ambulance I’m watching her carefully trying to observe anything that might give me a clue as to what was happening; stroke? drug use? psychosis?... no sign of trauma… hmm... fake symptoms? hypoxia? metabolic cause? Was she hypoglycaemic?….nope. What was going on here?

With a lot of effort I managed to get a baseline set of vital signs an oxygen mask on her for a total of about 3 seconds, then she rolled onto her stomach on the stretcher and despite repeatedly turning her back over she kept screaming out when touched. She had adequate blood pressure and pulse and was breathing well. Eventually I figured I’d leave her alone and just hold the oxygen mask right near her face – I was sure if she was having a cerebral event then the effort of fighting our attempts to assess her would be doing her intracranial pressure no good at all. Hospital was nearby so it was fortunately a short trip. When we arrived I got that look from the triage nurse as which said; why are you bringing in an altered conscious state patient lying on their stomach? I explained how combative she had been and as the staff tried to help us move her off the stretcher it soon became evident to them too. I left them with a diagnosis of “Sorry, I just dunno” – I guess that’s why we brought her to hospital.

Late in the shift when we went back to the same hospital we checked back to see how she was doing – I was surprised to see she’d been sedated and intubated. They’d done a scan of her head and found nothing, checked her blood and spinal fluid and again found nothing. The doctors were talking about possible postpartum psychosis, but they too were scratching their heads. I came back the next day and again asked if they had found anything. But they had transferred her to another hospital when they found after extubating her she was worse, even more irritated and combative. I really hope she was ok.

That's a negative ghostrider

Yesterday we got a selcall telling us to head for a small commercial and domestic airport nearby. A plane was coming in and was apparently in trouble with 3 people and 700 litres of fuel on board. It was a small twin engined plane with issues with its landing gear. I straight away (and very professionally) thought Cool this should be worth a look!

We jumped in the truck and headed out to the staging area where we were meeting the other emergency services, thinking we would find a single fire truck and some old guy from the airport telling us where to park. We pulled off the freeway and there was an absolute sea of flashing lights, police cars, fire trucks, airport vehicles, ambulances, managers, about a hundred people all milling around wearing reflective yellow vests. Not wanting to be left out, my partner and I donned (I love that word) our high visibility gear and went to find the commander in charge.

We were told to follow a couple of fire trucks out onto the tarmac area to standby. The plane was going to do a fly-by of the tower to see if the landing gear was down. Fortunately it was, but the lights in the cockpit said otherwise so we were all poised, ready to clean up the results. After circling for a while to dump fuel, finally the plane appeared again and there was a brief tense moment as it touched down when we all waited to see if the landing gear would hold. I'm happy to say it was a textbook landing and the plane rolled to a stop without incident. So I'm slightly bummed I didn't get to see them bury the plane in fire retardant foam, but I'm glad everyone was ok.

We took off our vests and cleared from the job after having a quick chat to some of the other crews there. Almost immediately the MDT let out that sound and we were dispatched to an Unknown Problem - Third party caller. That pretty much says it all. Armed with just slightly more than no information we headed back out into the afternoon.

Green Grass

Its been really busy where I work lately. Who knows why and there probably is no real reason. I've given up looking for reasons, public events, full moons and weird calendar dates like 06.06.06. That's just the way it is. On the day shifts we've been leaving branch before 7 am and getting back late, often without so much as a glimmer of a meal break. I've been living on muesli bars and diet coke out of my bag in the truck. Really healthy stuff.

On the night shifts it just doesn't stop. Back to branch to re-stock and then out again for more. Its strange when you then talk to some of the other cars who are only a suburb or two away and get told they have not turned a wheel after midnight. I know the dispatchers are trying to maintain coverage, but surely they could drag a couple of the quieter peripheral cars out of bed and get them to take just a few of the jobs, You know, maybe share the love a little?

The upside of this (there is always an upside) is that I've been getting home so tired that I have been sleeping really well after night shifts. Despite being loaded with caffeine I'm managing to sleep all the way through til mid afternoon when my alarm goes off. Although all the stuff I usually get up and do between nightshifts is getting neglected. My neighbour just asked me if I'd like to borrow his lawn mower - do you think he's trying to tell me something?

Rugby

I took a night off and went to an English pub the other night to watch the rugby. England Vs the Wallabies in Sydney. I figured it would be a bit of rowdy fun to watch the crowd get all worked up as England did the usual and kicked the "wobblies" out of the park. When Australia ended up winning 34-3 there was a fair dampener on the mood. Everyone turned their backs on the TV, started downing even more pints and talking about the World Cup instead. Stangely I woke up with a headache.

Mobile phones

About 10 years ago I got my first mobile phone. It was a great big clunky thing that ran on a now defunct network. Reception was pretty ordinary but it soon wangled its way into my life, quickly becoming an “essential” part of my every day. I soon developed a kind of pre-flight check as I left the house each day that comprised of patting various pockets and saying out loud “wallet….keys… phone”. Now if I forget my phone somewhere I get the same feeling I used to get if I misplaced my wallet; a brief flash of fear followed by the creeping realisation that if I don’t have my phone, then I’m screwed, how will I get all my numbers back?, no one will be able to reach me!

I vaguely remember my life before I grew that digital appendage, before I became slave to the mobile millstone, but what I can’t picture now is how I actually managed to function without it. Australia has one of the highest uptakes of mobile phones in the world. We can’t get enough of them. Just about everyone has one and it is rare that you meet someone who doesn’t. In ambulance this has changed things - a lot. On the plus side mobile phones have given many people access to emergency services a lot quicker than may have been the case in the past.

Now however, all 25 bystanders at an event will now call the ambulance rather than one person heading down to the nearest phone box, so there may be multiple calls to one event. People driving past an accident (or even past someone asleep in their car) will now call an ambulance without actually stopping to see if one is needed. As a result they can’t give the calltaker any details because they are now 10k away down the freeway.

The biggest change that I see in my little pre-hospital window of time is that carloads of concerned relatives will now get to the scene before the ambulance does and then continue turning up while you are there, often blocking the street with their cars making egress impossible. Just when you have calmed down an already elevated and hysterical scene another car will pull up and it’s all on again. I now often find myself deeply concerned with the wellbeing of the convoy of hysterical relatives following the ambulance to hospital – on more than one occasion now I’ve had to pull over the ambulance and walk back to tell the procession to settle down before they cause another accident.

Mobile phone use is insidious and pervasive. I say this because a few days ago for the first time, I used a mobile phone as an assessment tool, I even used it in my handover to the triage nurse at hospital and she didn’t bat an eyelid. My patient was pretending to be unconscious. She had called her case worker and told him she had taken an overdose, he had done the right thing by his client and called an ambulance to attend and make sure she was ok. She was able to walk and talk just fine at the scene but suddenly in the back of the ambulance she was only able to be roused with a lot of a shoulder shaking and a loud voice… until her mobile phone rang. At which point I think she forgot to be unconscious and answered it – asking whoever it was on the other end to “bring me in some smokes will ya”. Then she ended the call and became “unconscious” again. This occurred a total of three times en route.

On arrival at hospital she was still “unconscious” and triage looked at me quizzically until I explained the mobile phone usage. As I went off to do my paperwork I saw the triage nurse heading into the cubical with a sly grin to protect the “unconscious” patients’ airway with a large nasopharyngeal airway. Let’s just say she was not unconscious for long. I headed back out to the car and the first thing I did was check my messages.

Friday night

Wow, what a night that just was. Forgive me if this is a little incoherent as I've been awake for about 30 hours now and I'm frazzled (is that a real word?). Shortly I'm going to bed, but I just wanted to write some stuff before I begin drooling unattractively onto my pillow for the next 8 hours.

We got into the heart of the city and saw humanity at its finest as drunken mates brawled with strangers and each other. We did however see a kid having a seizure (it was his first one, so he got to go to hospital for investigation) and had a few patients who actually needed an ambulance.

About a third of my patients last night were in police custody for various reasons. Some had been fighting and had lost, some were PFO's (pissed and fell over), some had been arrested for drink driving and now thought that a theatrical "I'll just throw myself to the floor and pretend I'm unconscious" was going to make the police charges go away. Wrong.

Its hard to pick my favourite job from the last 24 hours...but here are some "honorable Mentions":

The young man who had just taken a big syringe full of amphetamines and was now feeling "jittery" and restless. Newsflash - that's what happens when you pump low-grade poison into your veins. He kept grabbing at me and saying; "You gotta help me - I'm dying". He wasn't and he didn't.

The bloke on the street corner who insisted on being taken right across town to a particular hospital because he had a really bad pain in his shoulder, oh and yeah, it was near his house - who then walked straight out of the ambulance, through the waiting room and went home. Ever heard of using a taxi?

The girl who was so drunk, she was lying in her own vomit and urine on the footpath and whose friends thought that they'd leave her there to sleep it off while they stayed in the pub to keep drinking. I wish I had friends like that.

A particular winner for me was the group of 16 year olds apprehended by the police with a shopping trolley full of household letterboxes they had been stealing - what the hell were they intending to do with them?

Choice

The other night my partner and I were sent to find a patient who had absconded from hospital during treatment for a life threatening condition. Because she had walked out on her treatment at hospital, and because a doctor believed she needed this treatment to continue living, the doctor had signed papers that turned her into a 'recommended' patient, essentially declaring her unfit to make her own decisions.

I should be fair and say that this is a temporary measure that gives police and ambulance crews the authority to transport a person to a facility for proper assessment by a qualified person and is not a permanent removal of the persons independence. However, I just found it a bit strange that for all intents and purposes this elderly woman was 'rational', had lived with this medical condition for many years and was apparently making an informed personal choice about her treatment. Yet we were directed to take her to hospital, to override her wish not to be treated and utilise police as required to make it happen.

I know some will see this as a passive suicide attempt by this patient, and perhaps it is, but what limits should we set on someone making a personal decision about their treatment? Is it whenever that treatment is likely to cause them detriment? (the medical profession allows people to make dubious health care decisions all the time) or is it whenever that decision may actually cost them their life? I don't know, but it just didn't feel right to me on the night.

Mornin' Rob

Its 4.pm. For the first time in months I've had a decent few hours sleep after night shift. I'm staring at the pile of cereal I've just poured onto the Kambrook sandwich grill and thinking through my cloudy haze that something doesn't look right. The cat circles around my legs trying desperately to get my attention. I know as soon as I feed her she'll give me the question mark (she looks like a ? when she walks away). It's an odd arrangement. All I'm apparently good for is providing food and a heat source on cold nights. Seeing that I'm off working most of the time I'm not brilliant at providing either.

I check the answering machine and listen to my messages - some of them are 3 days old already. Letting out an exaggerated yawn, I put on a big pot of brewed coffee. It usually takes me a few cups to get a clear head. I jam my nose into the only milk carton in the fridge. It fails the sniff test miserably and I recoil cursing. Scratch about for some coins and walk down to the local shop. People are driving home from work and kids are getting off the buses after school - I feel really out of it - a strange disconnected feeling. The cat meets me at the front gate and then follows me inside pleading for attention. Ok ok! Phew... still one can of cat food in the cupboard. She takes one sniff, looks at me and walks away. Great.

I get four days off. I have just slept through my first one and there is less than an hour of daylight left. I will sit watching tv or reading a book for the next few hours before going for a run. Then its dinner and an early night. The real days off start tomorrow.

The missing piece

I just completed my first night shift with a nice bloke who I haven't worked with before. We took over from the day crew and were told it had been a 'reasonable day'. Hmm... was that good? Did that mean it was going to continue to be 'reasonable' or did it mean we were about to have one of those nights?

We had a couple of interesting and challenging jobs fairly early in the night. First up we went on a Signal 1 call to a young girl of about 18 months who was in apparent respiratory distress. We arrived and found a very cute girl with beautiful black curly hair and huge eyes clinging onto her mothers leg in the hallway. I just re-read that and yes, the leg was still attached to her mother.

As with so many of the families where I work - nobody spoke much English. Sometimes there will be a very young family member who has been educated here in Australia who can act as translator for you. This is usually a great way to get answers, although often you need to be very strict with your questions because you will ask "Does your mum have pain in her chest - yes or no?" The kid will turn to mum, there will be a 4 minute long conversation and the answer will come back "she is sick, she doesn't feel well, she doesn't like going to hospital...". Utilising the kids is often your only option and can provide its own curly issues - asking a 7 year old to help ascertain if his mother's waters have broken can require some dexterous verbal gymnastics.

Anyway where was I?... ah the kid and the leg. It turns out she had been "breathing funny" when she was down for sleep. She had been treated with antibiotics about 2 weeks ago for a chest infection but according to family it was gone now. We did a really thorough assessment of the little one and found the only thing amiss was a slightly elevated temperature. She had clear lungs, good heart rate and respiratory rate, she was active, happy and reacting appropriately to mum and everyone around her. But mum was insisting she was sounding strange when she was in bed so we stuck around to observe the girl while my partner did his paperwork. Everything checked out, but as always with kids, we offered mum a trip to hospital for a check up. She declined so we suggested that she take the girl to her local doctor - and she agreed. Hmm... but what were we missing?...

We packed up our stuff and I stopped playing with the kid and helped carry bags out to the car. We were just going through the front gate when there was a single barking sound from the house behind us. Aha! the missing piece of the puzzle. The seal-like barking cough that comes with croup is such a distinctive sound, you only need to hear it once and you have a 99% accurate diagnosis.

We turned around and went back to let mum know what we now thought was going on and to reassure her that croup in its early stages is ok but needs to be watched carefully. Trying to put all the pieces together is one of the things I really enjoy about this job.

officially useless

I've just had a few days off and changed lines on my roster so I earned a couple of extra days away from the ambleeance. I have to say it was rather nice. Back to business today though and it sure was business as usual. We went to Chest pain, leg pain, head pain, vomiting, epistaxis, lacerated (by accident) and last but not least; need a sick certificate for work. Yep, we got called to a guy who has had a pain in his back for 3 years which he has seen a number of doctors about. He said he didn't get to the clinic before it closed and he needs a certificate to say he is unfit for work tomorrow, so he rings '000' and asks for an ambulance.

I tried to explain that we don't provide that particular service and that we'd be happy to run him up to hospital or even arrange for a doctor to come and see him at home. Not good enough apparently - he got all cranky and told us we were useless. Several more offers were made to help him before we wandered back out to the truck to go and be 'useless' elsewhere.

Bedtime Story #2

Prompted by a story over on John Robertson's blog about breaking in to people's houses, I remembered a funny job from last year.

My partner and I got dispatched to do a welfare check on an old lady that hadn't turned up to collect her prescription medicine from a pharmacy for a couple of days. The pharmacist had to contacted the local doctor and found out she'd missed an appointment there too, so after trying to phone her, he contacted the Ambulance service. Nice to see there are still some caring souls out there.

I've done a fair few of these kind of jobs and they can be a little unpleasant - you often have to force a window or a door and go in, sometimes only to find you are too late by a matter of days.

We arrived and went through the process of knocking loudly on the door. All the blinds were drawn and there was no answer. We couldn't get around the back to try the back door because of a big steel fence. I tried to open a sash window and saw it had a small nail holding it closed from the inside. With a bit of huffing and puffing I was able to bend the nail and force the window up. We let our dispatcher know we had gained access and were going in for a look. I stuck my head in the window, parted the lace curtains and called out "hello?"...... silence.

I told my partner he’d better follow me in through the window – we’re a team right? He called me a big chicken and suggested he’d wait out front with all the bags for me to go in and open the front door. I couldn’t come up with any kind of argument that his was a bad idea so in I climbed. I kept calling out hello.. anybody home? Nothing but silence. I really hoped she didn’t own a big hungry dog. The fact that I was getting no answer left me thinking this was probably not going to end well. Whenever you are in somebody’s house like this without being invited – it is a very strange feeling.

I went out of the lounge and into the hall to open the front door. I grabbed the lock and tried to turn it. Nothing happened, it was locked from inside with a key. Damn. I called out to my partner and told him my predicament. He helpfully began laughing while I searched the hall table for a key. I’m searching among the dust and jars of potpourri, when I hear a voice behind me. What are you doing in here!! I whirl around and there is a very, very old lady, in a dressing gown with crazy looking white hair and a walking stick raised ready to brain me. Ahhhh! I think I said a word I would not normally utter in front of an old lady and quickly told her I was from the Ambulance and we were just there to check up on her. She was very deaf and hadn’t heard me calling out. I persuaded her I was not a robber and she put down the stick. Once she finally found the key and let my partner in – who by this stage was wiping away tears from laughing so hard – we found out what had been happening.

The old woman had been feeling ‘poorly’ for the past few days and decided she would go get her tablets when she was good and ready. I told her that people had been trying to call her on the phone and she said “that thing is always ringing... I never answer it anymore”. We checked her over thoroughly and after finding nothing obviously wrong, we contacted some relatives who promised to come over to spend some time looking after her until she was feeling better. I hope they did.

The basic structure

I had a question in another post from Medic who asked what the structure of the ambulance response was here in Melbourne. Basically the system here is probably pretty similar to many others. We have a multi level system that has non-emergency or routine transport cars that might take patients to regular dialysis appointments for example. We also have your normal ambulance (usually a Mercedes Sprinter) which has two paramedics on board. This can be two fully qualified paramedics, one fully qualified paramedic and a student paramedic or two 2nd or 3rd year students. We also have MICA (mobile intensive care) ambulances which have two MICA paramedics on board. These guys have a similar vehicle but carry more drugs and can intubate in the field. There are also MICA single responders and Clinical support officers who often drive around in Subaru Foresters that are very nice to drive. Recently the bike squad was introduced too. I think I wrote about them a while ago.

Oh and I shouldn't forget to mention the boys and girls in the sky - we have fixed wing planes and helicopters too. And..we get assistance from fire brigade first responders and several community first responder teams. Apologies to anyone I left out.

The more serious sounding jobs will get a dual response with a MICA ambulance and a standard ambulance being sent. If it gets crazy busy then there may not be enough cars around to send two, and you are then on your own. We have phone and radio support from a medical clinician if we happen to need it - but you can't call them up and say "um.. what do I do now?" - you need to ring them with a plan of action and a justification for wanting to go outside normal guidelines and protocols.

We have this thing called "the grid" which is the program that is used to dispatch us on Signal 1, 2 or 3 responses depending on the answers given to the call takers. Many jobs are reviewed by a senior clinician after they have been dispatched and upgraded or downgraded accordingly. This method seems to do a fair job of weeding out the jobs that have got an 'overly enthusiastic' response given out by "the grid". We have had the recent introduction of a 'referral service' where a team of specially trained paramedics actually ring many callers back and spend time talking to them to see if another service (such as a locum) might be more appropriate. This works well to eliminate many non emergency calls. And of course occasionally jobs will bounce back through after more info reveals a potentially serious problem.

Yes our dispatch system has major flaws like every other one does, but overall I think it works... most of the time.

Dread

A friend of mine recently asked me what were the worst jobs for me personally. I told her that it was anything involving really sick kids or grieving parents. I still struggle to actually talk about some of these jobs but I told her I'd write something about one of them here.

Driving along, coffee in hand chatting happily to my partner. Bamm. The radio announces that job I had most been dreading. A paediatric arrest. A 2 year old child, put down to sleep and found pulseless and non breathing a short time later. We discussed on the way to the job who was going to do what, and as I had managed the airway at my last (adult) cardiac arrest it was C for circulation for me this time. My partner and I were both secretly praying MICA or another crew would get there first. They didn’t.

We arrived at the same time as an MFB (Fire brigade first responder) crew who were 10 steps behind us on the way in – mum was at the door looking strangely calm as we walked up and were led to a kid’s bedroom. There was dad doing CPR on a tiny little body on the floor. Oh Crap this is a real one. Pucker factor of about 10/10. I felt physically sick. A microsecond pause as we both took in the scene before us and then it began. My partner quickly had airway under control, suction, then in with one of those tiny plastic OP airways you hoped you would never need to use, baby bag-valve-mask and some O₂ flowing in. No pulse could be felt or heard, damn. … one of the fireys was asked to begin CPR. Sit rep to the other cars that were coming… “confirm full arrest”.

I was desperately calculating the joules in my head in case we had to defibrillate her as I cut the Little Mermaid pyjamas off and put the paediatric defibrillation pads on the tiny pale body. Mum and dad are just outside the room and that horrible noise I can hear is a mother in the worst kind of pain I can imagine. I dare not look at her as I’m not sure I’ll be able to hold it together. The monitor shows a sluggish EMD bradycardia at about 15 bpm. This kid looks just like child of a friend …don’t think about that…Concentrate. More CPR, some attempts to get a history of what had happened, a pause …. asystole on the monitor. CPR again… Return of the bradycardia at about 20 bpm.

MICA arrived. Thank god. Tears of relief welled up in my eyes and I had to blink them away and focus on what we were doing. Handover was a blur. Next thing I was prepping a bag of fluid, drawing up some adrenaline and pleased not to be making the hard decisions anymore. Intubation was tricky but the guys did amazingly well with the tiny airway. I notice the MICA guys hands are shaking too. Another ambulance crew appeared and began talking the parents through what was happening. I sent someone out to get more oxygen from the car, then swapped out with the firey and began doing CPR as MICA tried deperately to get IV access.

Drugs, CPR, pause, more CPR, check the monitor… 30 then.. 40 bpm….

Come on -I’m willing the monitor to show more beats. CPR again, I look at my watch… we’ve been at this more than 30 minutes already. More CPR…then suddenly the rate on the monitor begins climbing…A pulse at last....We all work together and get ready to go, I slip my hands under her little back and scoop her up in unison with the other guys. So many hands holding so many tubes, wires and fluid. We all shuffle for the front door. Onto the bed and the heart rate is now 130. Still no sign of any breathing and we quickly load, breathing for her as we go.

We drive the MICA guys, the girl and her almost catatonic parents in to the hospital. Sitting next to her mother in the truck I can’t find any words to say, I feel useless. Come on…say something. I can’t even comprehend what she must be going through. I just try to explain what is happening - I don't know if she is hearing me. Into the trauma room, we give handover and suddenly my part in all this is over. I hear someone in the hallway say they don’t think she’ll make it. I know they are probably right. I head back out to the car to write my case notes, there is a huge lump in my throat and I feel like dropping my bundle – not now, that can wait til I get home.

Over there...we got us a waver

All right I don't quite get it - you or someone you know has called an ambulance - thats good. I would too if I needed one. While waiting for the ambulance to arrive you decide to go out front and wait for it to come. Again - I can understand that, the waiting must be terrible sometimes and we all have our different way of coping.

Most people stand out on the street and when they see the flashing lights come down the road, they'll step out and wave - this can be magic for an ambulance crew who suddenly don't have to be counting houses, squinting for non-existant house numbers and trying to work out where Unit 2A of block 4, 42-45 East-something-court is while driving at a rate of knots. You look up and there is someone doing 'the wave'. This can be a slow one arm "Look, I'm a tree in the wind" impersonation or it can be the double armed "If I do this fast enough, I'll actually take off" method - both will get our attention and I'm usually very grateful.

There is another method which I'm stuggling to get my head around and that is the ESP method. When an emergency services vehicle goes past most people have a look, a few don't but most will stop and stare for a second or two at least - go on, I know you've done it. I still do it! But this other group of 'wavers' will stand out the front of the house and just stare as you go past, obviously sending you powerful ESP messages that you have arrived at the right place....and have in-fact driven past..... and that you should turn around and come back. No wave, no smile, no yell, no raised eyebrow, no nod, nothing. We do a 17 point turn in the tiny street with cars on both sides and finally arrive - where we're often asked; didn't you see me? I always try to answer this question with my mind, but I'm not sure I'm getting through. I'll have to keep working on it.