Sunday, April 30, 2006

Pain in the neck

We recently had some changes to our protocols for the treatment and assessment of potentially spinally injured patients. In the past we were bound by our guidelines that if a patient in a car accident had even mild neck pain but had a sufficient mechanism of injury, then they had to be collared and fully spinally immobilised - regardless of the absence of significant symptoms.

Paramedics were taking patients in to hospital and despite being reasonably certain that the patient had only a soft tissue injury ( completely certain can you be about anything?) , the person ended up being probed and prodded in all sorts of ways that are usually reserved for alien abduction stories - this not particularly pleasant for the person and very resource intensive for the hospital who have to allocate time and staff to monitor and "clear" the person's spine before they can be allowed to move freely.

Our new protocol allows us to make a clinical judgement in the field and determine the direction of treatment based on what we find - taking into account the patients history, the mechanism, the symptoms, pre-existing medical conditions, age etc. I think this is a great step in the right direction. It seems to be getting a positive reception at the hospitals too - I'm not seeing the triage nurse groan everytime we bring a minor "whiplash" type injury through the doors.

Actually my own neck is killing me after my last round of shifts...must have tweaked something somewhere. Quick I'd better call someone... :)

Thursday, April 27, 2006

Oh Boy

Me: So let me make sure I have the story correct; its 4.00 am, you have stayed up all night, you have just taken your normal prescribed amount of medication, just like it says to do on the box here, and you have called an ambulance because you are now feeling drowsy and tired. Is that correct?

Patient: yeah.

Me; Ok, so what do you actually take this medication for?

Patient: (looking at me like I'm an idiot) It’s a sleeping tablet… to help me sleep.

Saturday, April 22, 2006

Bedtime Story #1

This is a little tale about some ambulance people I know working in the inner suburbs.

Late one afternoon, two ambulances are dispatched to a single car motor vehicle accident in a suburban street. One of the ambulances is going on a Signal 1 (lights and sirens) response, the other is driving towards the scene at a more leisurely pace (Signal 2), waiting for the first car to arrive on the scene, assess the patients and decide whether the second car is required. If it is, the second car is usually just a few minutes away and can come in and assess and treat if there is more than one patient.

A short time earlier, Sharon and Trevor (not their real names) went shopping at the local supermarket. After paying for their shopping with a credit card and thereby leaving no doubt as to at least one of their identities, they head for the exit, deciding on the way out the door to grab a flat screen TV and some other smaller appliance that were on handy display by the exit. So Shazza and Trev leg it for the car with a couple of spotty-faced, $8.00 an hour employees in hot pursuit. They make it to the car and with screeching wheels, they make a clean getaway out of the carpark without running down a single nanna. Trev is driving and he makes it all the way down the street to the first corner which he handles beautifully... until the car mounts the curb and runs headlong and dead centre into a power pole.

The first ambulance arrives on scene at around the same time as two out of breath and wide eyed employees arrive from the supermarket. Trev is on the phone and despite his obvious lower leg injuries that prevent him from running away, he is busy trying to arrange the quick sale of his recently acquired electrical goods to an acquaintance. The ambulance crew have to ask him several times to put the phone away and speak to them about his injuries. First things first.

The second Ambulance arrives a few minutes later, as do several police cars. Sharon is sitting in the passenger seat, her obvious pinpoint pupils suggest she may have a narcotic in her system and the crew is wary that this may mask her perception of any injuries. Both Shazza and Trev swear (oh yes officer) that they were wearing their seatbelts, however the Trev's leg injuries and the obvious mark on the dashboard from Shazza's makeup and lipstick tell another version of events. Trev is loaded into one Ambulance and Shazza is loaded into another. The police climb up into the Ambulance and place both of the master criminals under arrest - warning them that if they try to run away while in ambulance care, they will also be charged with "escaping".

The convoy of ambulance and police vehicles head off to the nearest hospital, where Shazza and Trev will be treated for their injuries before being taken back to the police station for "processing". Shazza tells one of the police officers at hospital that she was "thinking of becoming a copper once". "oh Really." he says. They are all in for a long night.

Monday, April 17, 2006


Well Easter has come and gone with the usual road carnage. A friend and I were driving along a 2 lane highway about an hour out of Melbourne on one of my days off and we passed a car that was sitting at a T-junction with a side road - the front of the car had been ripped off completely and there was debris all over the road. I could see two people still in the front seats. As nobody seemed to have stopped, I chucked a U-turn and pulled up to see if everybody was ok.

The driver told me they had been driving along the side road towards the intersection with the highway - he'd pulled up late at the stop sign and the nose of his car had crossed the line into the lane where the traffic was doing 100 kph. At that moment a semi-trailer, a fully laden 18 wheeler, had come past tearing the whole front of the car off. Fortunately the driver and his young son were shaken up but unhurt. I asked if there was anything I could do for them, but they had a tow truck on the way already.

On my way home I got to thinking how close that was to being yet another Easter 'road toll' statistic. Really if that car had rolled even 6 inches further before stopping, the car would have been impacted and spun violently rather than just clipped. I suspect the outcome might have been very different. It rained really hard on the trip home and as always I saw people speeding, overtaking on blind corners and apparently believing they are invincible. If there is one thing I have learned, it is that this job soon teaches you that people are many things ... and invincible is not one of them.

Friday, April 14, 2006

At least try to play nice

Sometimes we get rostered with the same person for a month and sometimes we are on 'reserve' which means we can be sent anywhere to work with anyone for a day. Working reserve is ok for a while but it is always nice to get settled at branch for a time. Its kind of like lotto. Sometimes you get rostered with someone you really click with and you have a great month, a lot of laughs and some interesting jobs. Other times you might not fully click with your partner, but overall it works ok, you both put in and get the job done. You aren't going to be lifelong friends, but you respect each other and its all good. Very very occasionally you'll work with someone who really irks you.

I just finished a shift with a woman I spent a month working with last year. This woman once again spent the entire shift doing the one thing that really upsets me in this job. She was routinely and openly rude and dismissive towards the patients we saw. She would make it quite plain that she thought people didn't deserve her attention and that she thought she was better than them.

We all get tired and grumpy and sometimes in this job you need to walk outside and bang your head on the side of the truck in complete exasperation at the behaviour of some people. But the key difference is that (I believe) you should treat all people with respect while they are your patient regardless of what you personally think about them or their circumstances. I even found myself going back and apologising to one woman's husband after my 'partner' had effectively said they were wasting our time.

By the end of the shift I was furious and embarrassed by her behaviour. Most of all I think I was mad at myself for not saying something to her.

Monday, April 10, 2006

3 foot high granny

Some oldies are fantastic aren't they? I'd had a complete prick of a night dealing with some really obnoxious and rather testing patients one of whom we transported to hospital only to see her walk out of the ED before I'd even finished typing up my case sheet. Staff at hospital told me she's been 'hitching rides' with ambulances across town, then just refusing assessment at hospital. She feigns chest pain and says all the right things so you have no choice but to run her into hospital 'just in case' it is for real. Very frustrating.

Anyway back to the nice oldies... My partner and I rocked up to a house where we were met at the front door by a 3 foot high granny who said "good morning..oh I'm sorry I had to bother you so early, its just I can't get Clifford off the floor". It turns out her husband had fallen in the bathroom which was about the size of a shoebox, and couldn't get himself up. We had some trouble getting into the bathroom because the door opened inwards and he was lying on the floor blocking the door. It took the two of us shoving quite hard to slide him out of the way enough to get in to assess him. Clifford turns out to be a very tall man for an old fella, and while I'm pleased to find he's basically unhurt, I look across at my partner and we're both thinking the same thing... how are we going to all fit in this tiny bathroom and get the big man back on his feet?

For a brief moment I think about getting the MFB (fire department) in to remove the bathroom door so we can drag this guy out into the hall and lift him up. His lovely wife is calling out from the kitchen and answering all my assessment questions for her husband; "no he doesn't have any pain... no he didn't hit his head...did you love.". Eventually I climb into the old pink enamel bathtub to get close enough to Clifford, my partner squeezes down beside the toilet, we each grab an arm and 1...2...3...up. We all almost end up in the bath but the wobbly old legs poking out from under Clifford's dressing gown manage to hold him up and we all do a funny shuffle out into the hall where my partner has a chair waiting.

The 3 foot tall granny is still happily chatting away, apologising and offering us a cuppa. We decline, but decide to sit and chat for a few moments to make sure everybody is ok. Eventually I askClifford; "Are you sure you don't want to go to hospital for a check up?". He gives me a wink and says "I've been through a lot worse..I'll just stay home and have a cuppa".

We said our goodbyes and headed out into the quiet street to see the first signs of daybreak. I love helping people like that.

Thursday, April 06, 2006


Theres been a lot in the papers here recently about the national chain of ABC child care centres and some rather worrying instances at a select couple of the centres where it appears child supervision lacking somewhat.

A mate of mine just called over and related to me a story of a friend of his who picked up her child from a child care centre (not an ABC centre) here in Melbourne just days ago. Once they got home, the child was noticed to be suddenly drowsy, irritable and lethargic. Off to the doctor they go. On the way, the kid produces 3 spectacular projectile vomits in the car ....why don't they put windscreen wipers on the inside? The doctor takes one look at this kid and calls '000'.

A 'probing' phone call to the child care centre uncovers the fact that the kid had a spectacular fall with a head strike during the afternoon, but staff didn't think to tell the parents or make any note of it. One emergency department, lots of head scans later and the diagnosis is a rip-roaring concussion.

Kids will always be kids, and you are kidding yourself if you think your average active child won't knock themselves silly at least once during their childhood. But you'd sort of hope the child care facility would at least tell you what had occurred, so you could keep a closer watch on the little tacker for a few hours. Wouldn't you?

Tuesday, April 04, 2006

Days off

During my days off I did an afternoon shift for some overtime. Hey, think of the money. This shift starts at midday and goes until 10.30 at night. We got off to a reasonable start and I even managed to get my coffee finished and read the Odd Spot in the paper before the first call. Not bad. By the time we actually finished around midnight and locked the keys in the safe I was thrashed.

We'd been to a beautiful nanna who'd broken her hip while cooking and had been on the floor for hours until the neighbours heard her calling for help, we saw a bloke who wanted us to help him "pick up me 'done" (methadone) cause he was having abdominal pain and said he couldn't drive down to get it himself, we'd been to a young mum and dad who's little boy had scared the crap out of them with his first febrile convulsion, and around 9 at night we'd seen a bloke who'd jumped off a 5th story roof - tragically for him there was nothing to be done. I was left wondering what could possibly have been that bad in his life. Mostly I was puzzled by the cab driver who bystanders said drove away at a rate of knots when the young man landed on the footpath nearby. I guess he didn't want to be delayed by any questions from the police. Bizarre, when a young life has just been extinguished right there.

We finally made it back to branch without getting anymore calls and I walked home - wasn't this meant to be a day off? That'll teach me to do overtime.