Saturday, October 22, 2011

A voice in the dark

When we arrive at an address after dusk we put our side scan lights on. Usually on both sides of the vehicle. One lot shining on your house and the other lot shining brightly in the direction of the house you live opposite from. This serves two simple purposes; It allows us to see our way across your broken concrete driveway, through the swampgrass front lawn, past the car that you are "gunna fix up one day" (until then your 11 cats will keep breeding in it) and up onto your porch where we can avoid the holes and the cans of butts out front - to help you with your problem.

Illuminating the other side of the ambulance allows us to unload our equipment and not get hit by some muppet who is so awestruck by the appearance of an emergency vehicle that any attempt to control the V8 Holden with the bald tyres is forgotten.

Tonight someone threatened to kill me. That is a voice came out of a half open sash window opposite and said that if I didn't turn off the light that was now shining on his house (allowing me to get my equipment out of the ambulance without getting hit by the aforementioned mobile muppet) he was going to shoot me. Wow.

Is it just me or are we getting less neighbourly?

Monday, October 17, 2011

Heavy eyelids part III

Ok time to get moving. We all knew this was going to be a challenge. The folding wheelchair was brought in and we carefully moved nanna across from the bed. As I moved her legs over to the footplate I was amazed by the size of the ankles and the sheer weight of the limbs. What I could see below the pressure bandages looked dry red and sore. With the CPAP device on, she soon stopped fighting the mask and appeared almost immediately more alert to what was going on. The monitor appeared to be settling down too with far fewer ventricular ectopics drifting across the screen. All good signs that things were settling down a little.

I carried the monitor and oxygen while one of the ALS crew struggled with the wheelchair. As we turned into the hallway I could see immediatley things didn't add up. There was no way were squeezing through between the piles of porcelain and the half open door. Dumping our equipment, my partner and I grabbed one end each of the fully loaded display and started dragging it across the carpet to where we could get it out of our way. The case tilted alarmingly and I saw we now had nannas full attention. I could hear her trying to say something to us from under the hissing mask as we grunted and heaved her precious collectables. She may have been saying 'don't worry if you break a few of those dusty old things fellas, I was going to throw them out anyway', but in reality I think what she said was something about my mother.

A few more nitrates later and Nanna's blood pressure was becoming reasonable again. We did a 12 lead ECG in the car, but there was nothing worthy of transmitting to the hospital. I gave a small amount of lasix via IV and I could see she had really turned the corner. Nanna was now doing well. I patted her hand and told her so.

I called up the duty Clinician to pass details to the hospital - he sounded fresh and alert and clearly just at the start of his shift. The hospital then came on the line and I handed over: "We are loaded with a 78 year old female, presents this morning with acute respiratory distress..." I rattled off the current vital signs. Another annoying alert and chirpy voice said; "Thank you, see you in 10 minutes."

After completing my paperwork, I wandered out the front of the hospital to where my partner was dozing in the car. I pulled open the door and he sat up with a start. That's payback for waking me up earlier. A couple of tired looking ED staff were sharing a cigarette off to the side of the ambulance bay. The sky was properly light now and my first day off was going to be spent sleeping. My eyes felt dry and my lids felt heavy. Now just got to make it back to branch without getting another job.

Sunday, October 16, 2011

Heavy eyelids part II

As we arrived at the address the street was still dark. This was not a wealthy part of town. The houses are usually 1950s cement sheet construction (often Fibro), low-rent government housing and very basic. At that time of day there is probably a hint of dawn in the sky but this time I didn't really notice. The smell of hot brakes wafted up us as we climbed out of the truck and went to get our bags. My partner was pulling his gloves on as I retrieved the monitor and our drug box. The sliding door always sounds so loud in a quiet street. I wonder sometimes if people curse us the way I curse the garbage truck on my days off...

The crew on scene were obviously into it, the sound of their monitor alarms could be heard coming from the half open front door. Everything seems to beep at you in ambulance, but the cardiac monitor usually starts to really complain when the heart rate is too high, too low or absent altogether. I hate persistent alarms and although we have the ability to silence most of them for a while, it is always important to address the reason the alarm is sounding, not just get rid of the annoying noise. I went to push the door open with the monitor and was met with resistance. Squeezing side on around the door I was able to get a look at why. There was a hall table behind the door preventing it opening. My head took a moment to gather what I was seeing. Everywhere I looked there were other hall tables and display shelving with literally thousands of china and porcelain plates, figurines, teacups. Oh and teaspoons, don't forget the racks and racks of teaspoons. This was a lifetime of collecting.

"We're in here" called one of the crew and I went into the front bedroom. Nanna was a big lady and was in trouble. She looked what we like to call pre-arrest. A friend of mine calls this "circling the drain". One of the ALS crew was kneeling on the bed behind nanna trying to hold her upright and hold a 100% oxygen mask over her mouth and nose. The other crew member was trying to wrap a blood pressure cuff around a huge arm. Both crew members looked flustered and red faced. I noted nanna's trunk-like ankles with pressure stockings around them, the grey purple hands, the sweaty skin, greasy hair and faint smell of incontinence. I could hear the gurgling of her breathing even through the mask. I was simply told "She's full". I turned to my partner and saw him already heading back outside to get what we needed. Good man.

Firstly we pulled nanna further upright and got her legs set on the floor then we jammed more pillows behind her to hold her body upright. I plugged her into our monitor and placed a probe on her finger to measure her current oxygen saturation. It came up as 76%. While these very low readings are not often accurate, it showed she was not getting what she needed through her wet lungs. I clipped and tightened a tourniquet around her forearm noting her clammy skin. She had her eyes closed and was clawing at the mask on her face. I grabbed one of the medication packets off the bedside table and found her first name. When I called her name, her eyes opened and she focused on me for a moment. Good, that's a start. "Squeeze my hands" I demanded loudly in her ear, she weakly obliged.

My partner returned and set about getting the CPAP device ready, (for those that aren't familiar, in crude terms this piece of kit blows a small but steady oxygen stream into the mask providing a reduction in the work of breathing and an increase in the efficiency of gas exchange in the alveoli) this device works wonders compared to trying to achieve the same principles through manually assisting the patient's ventilation.

After many attempts, Nanna's gargantuan arms finally gave up their fiercely protected blood pressure readings - 165/105. Right then, nitrates please, to reduce her blood pressure and give her heart a chance to catch up. I managed on my second attempt to get IV access in a tiny crooked vein on the back of her thumb. It was a pathetically small IV, but any port in a storm will do!

I'll write more in the morning... right now I need to sleep.

Friday, October 14, 2011

Ambulance service (Still) in Crisis

Rant warning.

Right, Its been all over the news in the last few days. Its now very public knowledge what all of us know already - the service is falling over, slowly. Response times have blown out and are reported to be at 20 mins for the 90th percentile of Code 1 cases. That means on average if you ring an ambulance on a busy night here you have about 90% chance of waiting 20 mins for it. You may be one of the lucky ones who gets an ambulance sooner than that - buy hey if you are ringing an ambulance - in theory, luck is not currently on your side. However you may also be one of the poor buggers who wait even longer than that!

An ambulance Whistleblower got mighty crapped off by the events of the last couple of weeks (as have we all) and went to the media:

This got the ball rolling and had the Ambulance Service spin coming out with a response that basically blamed:
1. the hospitals for holding us up (Which they do a lot - but proper funding will address this)
2. those lazy paramedics for using their sick leave.

There was no mention of the service itself having an undeniable role in eroding the standard of ambulance coverage through neglect and mis-management. The reason paramedics have sick leave available to them is because they are exposed to a lot of sick people - we have stressed immune systems. We also work shift work, which also makes you more susceptible to illness. We don't eat at regular times and struggle to maintain regular fitness regimes. We deal with an unsupportive management, a low morale work environment and ever increasing workload with ever decreasing conditions.

We are now one of the busiest ambulance services in the country and among the lowest paid. Thank you Mr Whistleblower for your efforts. Lets hope for the staff and the public, something comes of this.