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.