New batteries

Dispatched to a psychiatric case at a tram stop in the inner suburbs. Apparently the person had been 'shouting at everybody' and had been asked to get off the tram. On the way there I pictured a bunch of travellers all huddled down one end of the tram while some mad old woman ranted and raved down the other.

We got to the tram stop and there was a little old lady sitting quietly at the tram stop with a couple of shopping bags at her feet. I walked up and introduced myself and asked her what was happening today, she frowned at me with a puzzled expression and so, I repeated my question. "I CANT HEAR YOU" she suddenly shouted at me really loudly, "MY BATTERY IS FLAT" and she pointed to her hearing aid.

Five minutes later after writing a few questions for her on a notepad, we worked out that she'd asked somebody for some help with the ticketing machine on the tram, only this person thought she must be a nutter 'cause she was shouting so loud, so they just walked away. She then asked for help from a few others on the tram, getting frustrated because nobody would help her (so she probably got even louder) before the driver finally stopped the tram and escorted her off.

A man sitting at the tramstop while we chatted to her offered to help make sure she got a ticket when the next tram came along. We thanked him, wrote down an explaination of what was happening to her, shouted goodbye to the perfectly sane "psych" patient and headed off to our next case.

Nursing homes

The more time I spend doing this job the more astounded I get seeing the conditions that so many of our elderly are living in. There are such extremes from clean, well lit, well-supervised and caring environments to the most foul-smelling, dank, depressing places. There are appalling staff to resident ratios every shift. I've seen a 60 to 1 ratio on a nightshift, where the staff member was so overwhelmed by the number of high care residents that she's had to call an ambulance at 3 am to manage just a minor issue with one of the patients.

Then there are the inevitable calls where you get there and the resident is really sick, but there is nobody there who knows anything about the person. You can't get a decent past medical history from anyone. Nobody seems to know what the person is normally like - is the fact they are drowsy and drooling a new presentation, or is this how they normally are? I've dragged several poor old blokes out of bed and off to hospital only to find out that this "sudden onset of right sided weakness" is exactly how they have been for the last 5 years.

You will also frequently see weekend staff at nursing homes off-loading a number of patients when they get in at about 10pm on a Friday night - suddenly they'll clean out their most high-care or (as I've actually heard them called) most annoying residents so the weekend staff don't have to deal with them. All of a sudden you have an emergency ambulance being called on a lights and sirens response to "sudden onset of severe pain". I get really mad and frustrated when I get there and the patient is asleep and the staff are categorically insisting on them being taken to hospital.

I'll rant more about this later.

The 6.30 am call

The 6.30 am call is always nasty. Its right at the end of your shift when your guard is down and you are quietly thinking to yourself that you are almost finished for the night. The call is often to somebody who is quite sick or worse, and you suddenly have to turn your brain back on and start operating at full steam, right just when you are ready to fall in a heap.

Sometimes its to a patient with acute pulmonary oedema (APO), who has been lying down all night with their lungs filling with fluid only to reach the point where they can no-longer breathe. Sometimes the elderly will wait "until a decent hour" before calling for an ambulance. As a result they can be very sick by the time you get there, apologising for bothering you and offerring you a cuppa even though their partner is almost dead in the loungeroom.

But occasionally the 6.30 am call is to the family who have noticed that grandma or grandpa is having a sleep-in today and has gone in to wake them finding them "unresponsive'. We get the call as a "Cardiac arrest - unwitnessed" and you know there and then as you head out to the truck that the outcome is never going to be good. With a witnessed arrest, there is a very slim maybe that if good CPR has been done and the universe is smiling upon everyone, that the person might be successfully resuscitated, and make it into hospital where the next fight begins. It is so very rarely that an unwitnessed arrest has a happy ending.

This morning was not one of those rare occasions.

Getting spat at

Well today I got spat at again. But for once I didn't even mind so much - normally when I get spat at, I get really pissed off and the person in question gets "appropriate" measures put in place to make sure it doesn't happen again. This time though it was an old lady with an aquired brain injury. Apparently she was once a sunday school teacher and now she sits around at her nursing home abusing anyone who comes near, hissing the sort of language that you don't expect to come from an old lady. These words seemed really out of place coming from her.

Apparently I was a "rotten bastard" (one of her more polite sayings) for taking her to hospital. She had haematemesis and was vomiting every half an hour. Her husband sat in the front of the ambulance with my partner and said "see what she calls me after 50 years of marriage?" Anyway when she couldn't get a rise out of me with all the insults, she chose to spit at me. I moved to a different chair in the ambulance and got out of the firing line. Every now and then she got a look on her face like she'd just realised the words that she'd said and she'd go quiet for a moment. Then it'd all start over. Getting spat on this time, well really I wasn't mad, I was just kinda sad for her.

Commonwealth games

Well the great Commonwealth games show is in town. It opened last night with all the pomp and ceremony that one would expect. The papers were saying it was "going to be a uniquely Australian spectacular". Our Prime minister looked as awkward as ever and She (the Queen of Australia) was there looking suitably well-preserved. I thought the most "uniquely Australian" part of the whole event was when Lord Mayor John So got a bigger welcoming cheer from the crowd than the Queen. I thought that was brilliant. One speaks the Queens English perfectly and the other has had to be subtitled on a few occasions. Pure aussie irreverence in full flight.

The ambulance crews are busy running round being prominent and available and as a result we now even have a bike squad. These super-fit paramedics are hooning around the streets on expensive looking mountain bikes and clocking up some impressive response times. The idea is that they can get through crowds of pedestrians quicker than a road car and can assess and treat as required. Then they call for a car to come and back them up. They have not apparently figured out the logistics of transporting patients yet. I joked with a colleague about them needing little lights and sirens on their bikes until I was shown that they do in fact have both already. Stupid me, boy was I wrong!

Interestingly I note there has been some resistance to bike squads in other countries as people seem to expect more than an out-of-breath ambo on a bike with a first kit. So what do you carry. How much gear is enough?

First night... 6 hours to go

Where I work, the roster is 4 days on 4 days off. Sounds pretty good at first. Until you realise that two 10 hour day shifts are followed quickly by two long 14 hour nights. Second nightshift is hard, but I have always found the first nightshift to be the worst. If you're lucky you have managed to get some sleep during the day before, but if you are like me, you just can't get quality sleep during the day. So by 1 am on the first night I can be really struggling.

I start looking at the clock and doing the maths to work out how much sleep I've had in the last 24 hours. Sometimes its a little scary. Then when I get home I find I'm totaling the few 15 or 30 minute blocks of sleep I've been able to grab during my shift and adding them to what I'm likely to get between my shifts. Its usually a sum total of about 5 hours. It's never enough.

When I get home after nightshift, I'm usually too trashed to read, so I crawl into bed and try to fall asleep.....Then there comes the inevitable knock on the doorat 9.30am just after I've got to sleep, from someone with a dodgy looking ID tag round their neck and a clipboard. It takes less than a millisecond even in my sleep deprived haze to realise they are going to try and sell me something. I'm too tired to get angry and usually manage to politely decline their offer of "5 rooms steam cleaned for $75 with a free upholstery refresher treatment" or inevitably something similar. Back to my pillow, where I spend a few minutes wondering if that was actually a good deal on the carpet cleaning before drifting off again.....only to be whippa snipp'd awake at midday by the Jim's Mowing guy as he manicures my neighbours lawn.

So often I give up by about 1.pm (er sorry, 1300 hours) and decide to get out of bed and do some laundry or wash the dishes from the last couple of days. Later on in the afternoon I hear my alarm go off in my room and I wonder why I bothered setting it at all. Drag on my overalls, drink two cups of coffee, make some dinner to take with me and head off to do it all again.

Hey wait a minute... thats not a stick!

My colleagues treated a snakebite in urban Melbourne recently. We actually had a few snake bite incidents that week. Lucky I was nowhere near them:

Snake breaks cyclist's fall

A man has fallen off his bike and onto a snake at Viewbank in Melbourne's north-east this morning.

Ambulance paramedic Damien Warrillow says the man was riding along the Yarra River when the accident happened.

"He's fallen off his bike and fallen on top of a snake by the sounds of it and he's been bitten on the lower leg either by a tiger or brown snake," he said.

"He had a couple of friends with him so they've applied first aid ... they've applied the appropriate bandages and tyre and tubes to the lower leg."

The man has been taken to hospital and is in a stable condition.

Here goes

Why gcs14? Well like a lot of people, I work funny hours. That means I'm often a little drowsy, often a little confused and sometimes I need a little prompting to do things.

I figure I'll write a little of what its like to be a paramedic, an "ambo" if you like, here in Melbourne, Australia. Hey I might last a day, or a week, or even a year. And sure nobody may read it and even less people may care, but hey it might help me get some sleep.