gcs14

Reg springs a leak

2007-07-01T20:21:00.000+10:00

We were way out of our usual area and it was late. I had never even heard of this particular suburb before, let alone been there. There were no available ambulances on that side of town, so my partner and I had been sent Signal 1 all the way across the city, flying along the wet freeway to try to get to a place neither of us had heard of. The job was given as a “Possibly dangerous haemorrhage”. I had the street directory on my knees and was calling out directions to try and find our way in to the big new estate with lots of dead-end streets. At one point we found our way blocked by a house. The map clearly said the street kept going, but the house in front of us was irrefutable evidence that it didn’t. Cursing, my partner hauled on the steering wheel and turned us around.

The house numbers were unreadable as usual so we took a small guess and pulled up out front of the only house in the street with a light on. Bingo! Our call-takers usually ask people to put an outside light on, lower the drawbridge and chain up the hounds. We like this because it usually means we don’t get eaten. However we do still occasionally turn up at houses with no lights on, large dogs running everywhere and padlocked 6 foot gates to try and get past.

Nanna met us at the front door - let’s call her Doris. She was wearing a dressing gown and looked like a normal old lady, except for the fact she was covered in blood. It was caked all down the side of her face and over her shoulder and front. She was wiping at it with a towel but much of it was already dried. She asked us to come inside and told us we were actually there to see her husband. We stepped into the hallway to be greeted by a scene out of a splatter movie. There was evidence of blood everywhere, Sprayed in arcs up the walls and all over the carpet. As we passed the bedroom Doris paused and told us that her husband Reg had been lying in bed next to her when she had woken because her face was wet. I looked in the bedroom and it was a real mess. Above the head of the bed the walls were sprayed with more arcs of blood which had dripped downwards. The sheets and pillows were dark red.

We were shown to the bathroom where Reg was seated on a stool in his pyjamas holding a washcloth to his head. “Hello” he said cheerfully “I’ve sprung a leak”. Carefully stepping into the bathroom to dodge the blood drops on the floor, I asked him what had happened. The sink and mirror next to reg were also covered in blood where he’d clearly been trying to get a look at where the blood was coming from – this resulted in an unusual bathroom makeover. Reg said he’d had cryosurgery that morning to remove a handful of skin cancers from the top of his head that morning. Cryosurgery uses (I think) something like dry ice to remove the spots and usually leaves a scab behind for a while. Reg told me he’d tried to stop the bleeding but it just kept going. Immediately I figured Reg was probably taking Warfarin which reduces the blood’s clotting ability.

Reg had obviously knocked one of these scabs off and somehow disturbed an artery. The scalp is highly vascular and tends to bleed a lot at the best of times, but Reg was clearly going for the record. I gingerly pulled the washcloth back from his head to get a look at the wound – a jet of blood sailed over my shoulder and I quickly pressed the cloth back hard. “Well I wont do that again in a hurry” I joked – very glad I was wearing my safety glasses. My partner prepared a dressing and bandage while I checked out Reg’s vital signs. His blood pressure was a little low and he had lost a fair bit of blood volume. We wrapped his head up like a mummy, got some IV access and loaded him into the ambulance. Doris was going to come along but changed her mind – I think she was aware of how much cleaning up she was facing. I hope there were some relatives to come over and help. We took the blood-soaked Reg in his striped pyjamas off to hospital to get his leak fixed.

I kept wondering what would have happened if Doris didn’t wake him up.

Fresh Air

2007-06-19T14:36:00.000+10:00

Here is a job from early this morning: My partner was driving and I was in the “jockey seat” which meant I was going to be assessing and attending to the patient when we got inside. As we were going to a child who was short of breath, we discussed the normal values for a child of this age on the way (repiratory rate, heart rate, weight etc.). Its only a rough guide and every child is different, but at that time of the morning it also helps to keep you awake.

The grass in the front yard was knee high and there were two cars in the drive, one of which had no engine and some cardboard for a back window. I could see my partner’s breath on the cold air as we waited for the door to be answered. In this area, the fences are all chainmesh and the houses are old Government Issue, made from cement sheeting and originally built for the 1956 Olympic Games. Many are now pretty sorry looking examples of public housing.

The guy who answered the door was talking on a mobile phone and waved us into the lounge room before walking out into another room to continue his conversation. It was hot inside and the cigarette smoke was thick making it seriously hard to breathe after the chill of the air outside.

The girl was maybe 5 years old and we’d been sent to assess her for an exacerbation of her asthma. She was sitting on the couch with her mother and another smaller child. She was coughing and sniffling and looking miserable. I asked her if I could have a listen to her breathing and she nodded. She flinched when I put it on her back and I realised how cold the stethoscope must have seemed after being chilled outside. I inwardly kicked myself. Sorry sweetie that must have been freezing. She was moving good amounts of air and did not seem to be putting a huge effort into her breathing, but she did have a clear wheeze when she breathed out. She was running a temperature and looked quite pale. Every few moments she let out a hacking cough that belonged in an old person’s body.

Her mother appeared to be nodding off to sleep while I assessed the little girl and woke with a start when I repeated my question a little louder; Have you given her anything for her asthma? She had apparently been given “heaps” of puffs on her Ventolin but was not getting any better. She had been coughing on and off ‘for weeks’ and tonight she would not stop. My partner made a comment about how smoky it was in the house and that was certainly not helping the girl get better. She sat up, looked at my partner and said defensively; “we never smoke in the house”. I looked at the full ashtrays on the coffee table, the bong (pipe) on top of the TV and the cigarette packets on every surface and made a poor attempt to hide my disapproval. I asked had she seen a doctor about the cough – and she hadn’t, so I said well she really needs to be seen by a doctor.

She probably had a chest infection and an exacerbation of her ‘asthma’ from the environment she was in. It was not going to get any better where she was. I treated the girl with some Oxygen, Ventolin and warm blankets as we went to hospital.

I took the nurse aside at the Children’s Hospital and explained about the smoke – she told me she could smell it on us all when we walked in. I sniffed my jacket, she was right. Rancid. She promised they would try and educate the parents about smoking in the house. I doubt it will make any difference. Yeah maybe the girl could have waited to see a doctor in the morning and she was inevitably going to be back in that environment in a few hours. But we left knowing we had given her and her little brother a few hours of smoke free air.

Two Fingers

2007-06-08T17:22:00.001+10:00

I have been a little lax with my updates. I will try to be more regular - note to self "Eat more fibre".

Last night was finger night. I'd hardly call 2 similar jobs a run of work, however when you don't attend a certain kind of work for ages and then suddenly you are off to two in a row - it does seem a little odd.

First was to a chap at a house that was being renovated. I think they were working back late on it and it looked like all the cousins and brothers were gathered to help. The place was well lit with those double builders lamps on stands and it was looking good with polished floors and fresh paint going on all the walls. Nice. The trail of blood led down the hallway to the bathroom where we found 70ish year old "Joe" who had sliced himself a beauty while cutting a piece of ceramic bathroom tile.

Joe was on wafarin to "thin his blood" and as a result he was not clotting very well. Still actively bleeding despite a handkerchief and a filthy tshirt wrapped around the wound. Joe had a deep slice running the length of his index finger and curving into his palm. It was going to need more than a few stiches to repair. We cleaned and rewrapped his finger using a big pad and bandage then wrapped him up like a boxing glove to try and stop the bleeding. Joe was asked to try and keep his hand elevated above his head, but he was so busy waving his hand and telling all the relatives how to paint, how to tile, where to put the rubbish etc, that I was contemplating tying his hand to the roof of the ambulance. Anyway despite his protests, we dragged him off to hospital where the hand specialists would need to have a look at him to decide how to put him back together.

Next we went to "Frank" the mechanic although he pronounced it "Frunk". I'm still not entirely sure how Frunk crushed his finger, as he had driven himself his doctors clinic going past 2 hospitals on the way. It seemed he had been working on a car when something (a chunk of engine maybe) had dropped on the back of his hand, which crushed and sliced the middle two fingers on his right hand. Frunk could close his hand into a fist with a great deal of pain, but was unable to then straighten his fingers again. This meant likely tendon damage in itself but when I inspected the wound with a torch I could see right through to the bones and damaged internal structures.

Frunk was in for a long night at hospital while the surgeons attempted to reattach his tendons and get his hand back into some kind of working order. I could see he knew he's messed up and this was going to impact on his work for a long time - if not permanently. It was of course up to his hand surgoen to tell him the prognosis. I gave him some pain relief, took the indecypherable letter from the GP and we walked out to the ambulance. On the way I tried to get more of a story as to what happened, but Frunk just talked round in circles. Sometimes you just never find out.

Ooops.

2007-05-22T16:53:00.000+10:00

A few days ago a crew was notified by the police that it was safe to enter a scene:
http://tinyurl.com/24oqnj

It turns out that decision was perhaps a little "premature" and now there are quite a few people on both sides of the fence having a look at what happened. This kind of thing has happened many times before with varying degrees of seriousness. These scenes are often chaotic, always difficult and I'm sure it's easy for human error to occur in the heat of the moment. I'm glad this time none of the people (police and ambos) who responded to this scene got injured while trying to help this patient, but I also hope this issue gets sorted out.

Escaped!

2007-05-11T22:15:00.000+10:00

After all this talk of prison last week I thought I tell you of a recent jailbreak. We found 87 year old Enid sitting outside the bakery in Glenroy. She’d somehow come to the attention of the staff who’d called an ambulance because they thought she must have been unwell. Enid was immaculately dressed, with her hair perfectly done, an ornate brooch, a pressed blouse and a simple handbag in her lap. My partner was astute (awake) enough to notice our Enid was wearing only one earring – women are definitely more attuned to that stuff - I have to look down and check that I’m wearing pants some days after nightshift, let alone notice what nanna is wearing. Anyway, despite being slightly miffed I hadn’t spotted it, I had to concede it was a good pickup. The missing earring said right away that something wasn’t right. And someone as well dressed as Enid was not leaving the house til everything was just right.

Enid clearly had some dementia. She would answer our questions to the best of her ability but then when she didn’t know the answer, would ignore us, lean forward and look down the street like she was expecting a bus to come along, or perhaps somebody she knew. If you smiled at her, she would return the most genuine smile and say “Hello dear” like she’d just met you all over again. She was beautiful old nanna and my partner and I were both ready to take her home. Sadly our service frowns upon you keeping patients as pets, so we set about trying to find where Enid was from. A few phone calls later and I spoke to the nursing home a few streets away – It turns out yes, as a matter-of-fact they do normally have a resident called Enid, but today they couldn’t seem to find her. Would they like her back? Why yes they would!

We made one last call to our Duty Manager to notify our intention to return Enid and her earring to the nursing home and then we loaded her up, checked her out and drove round the corner to the home. I rang the buzzer and chuckled as I said “are you missing an Enid?” into the intercom. I let the staff know about her missing earring and they promised to look for it. Apparently that morning Enid had got all dressed up as she always does and “headed off to church”. Usually she is apprehended at the door before she gets far, but today she’d somehow made it past 2 key coded security doors, out of the grounds and down to the local shops. Not a bad escape for an 87 year old in broad daylight. We waved goodbye and then headed off to our next job.

Do not pass 'Go'

2007-05-07T00:26:00.000+10:00

Well I finally got sent to jail. I knew they'd eventually catch up with me one of these days. Actually, I got sent to jail (or Gaol if you prefer) 3 times in two days!

First it was to Juvee (juvenile) jail, the children's 'prison' for a chest pain. I could tell the medical staff there thought the young man was "putting it on". I thought so too. But everyone was erring on the side of caution so we took him to hospital along with a carload of minders who would have to sit with him until the doctors decided he was clear to head on back.

Next day it was off to one of the city Police Stations for a prisoner who was having a seizure. This guy was doing a pretty good job of it too - except he was opening his eyes every now and then and looking around to see who was watching. I have found a lot of people in police custody think that if they get taken away in an ambulance, whatever charges the police have laid are suddenly going to disappear. It rarely works. People invent all sorts of medical complaints and an ambulance has to come down and check them out. Often we all know its crap - the prisoner knows its crap, the prisoner knows that we know its crap and the hospital staff give us 'the look' because they know its crap too. Everyone is busy covering their butt.

Last thing before we knocked off for the day, it was off to the Remand Centre in the city. This inner city prison is the full deal and security is tight. Our patient was 'generally unwell' and although he was simply complaining of stomach pain and nausea, he was a bit agitated and twitchy. He kept yelling out to someone who was obviously held somewhere near enough that he figured he could be heard yelling his obscenities through the walls. The staff kept telling him to pull his head in and answer our questions. There was clearly a lot more going on than we were party to. After checking him out, we saw that he wasn't dying and the medical staff had him well under control.

We got out of prison for good behaviour and felt very grateful to be going home.

Anniversary

2007-04-22T15:36:00.000+10:00

Oh dear - I'm hopeless. I have just realised I have missed my blog's anniversary. Along with a few other things in my life, it has fallen victim to the post nightshift haze. Here was I thinking I'd only blog this stuff for a couple of months. Then I said to myself I'll keep going til Christmas, now more than a year has gone past and I'm still tapping away, albeit somewhat sporadically!

Thanks to everyone who has been visiting, reading and posting, it has been great hearing from you. And of course lets not forget those who are occasionally spamming the comments section, your generous offers of cheap software, viagra and share market tips really make my day :)

Anyway I don't have any candles, but there is one beer in my fridge - it seems only fitting to drink it now.

Grief

2007-04-22T15:32:00.000+10:00

We all know different cultures handle grief and loss differently. For some grief is a very quiet, private and solemn affair. Some wail, pull at their hair and make a lot of noise. Still others might dance and sing. Each person goes through a grief process, dictated by their own feelings or culture. And yes much has been written on that grief process. In my work as a paramedic I have seen grief handled in many different ways, sometimes surprising ways and sometimes wholly expected.

The other night I was asked by a family to transport a woman whose main complaint was grief. She had suddenly lost a relative in a conflict overseas and after much open and vocal grieving had now ‘shut down’. She was not talking to anybody, was lying on the couch, refusing to open her eyes, refusing eat or drink and was worrying her large family who had gathered around her. I struggled a bit on the night as to what was the best course of action for this woman, she wasn’t physically unwell and although you could argue she had experienced some kind of emotional breakdown, she was actually grieving, and grief is something that I don’t think western medicine handles very well.

Her family were adamant that she needed to go to hospital and be seen by a doctor, she appeared to be wishing we would all go away (yeah I know that’s me projecting onto her) and in the end even after we suggested that a locum doctor (home visit) might be more appropriate for her – meaning she would still be seen but could remain at home rather than waiting at hospital – the family insisted that we take her. I’m still not convinced it was the right thing to do.

Has anyone else been to something like this?

Ice.

2007-04-02T17:54:00.000+10:00

The young man was lying on his back on the footpath outside a drive-through bottle shop that had closed for the night. It was midnight on Friday night and the streets surrounding the main strip in inner-city Fitzroy were busy. There were two men crouched over the figure, one sitting on his legs holding him down as if he were about to float away. He wasn’t moving. In hindsight, the usual crowd of onlookers was absent – only a few people were standing a short distance away. That should have given us a clue that something here was out of the ordinary - but it didn’t.

We had been dispatched to the case as a Signal 2 job and the data terminal just read “Unknown problem – Is standing or talking” – these jobs are usually psychiatric issues, alcohol related or drug affected. Sometimes all three. We parked in the driveway and flicked on the spotlights to light up the scene a little better. As we got out of the ambulance a police van pulled in behind us – my partner and I exchanged looks. There had been no mention of the police being dispatched on the data terminal. Sometimes multiple people will call for help when something untoward happens in the street – some people will call the police, some will call an ambulance. Sometimes the two services don’t communicate very well and we both arrive looking surprised to see the other.

My partner headed over to talk to the police and I grabbed the Red bag and walked over to where the people were holding the young man down. I could see straight away that he had his eyes open, was clearly breathing and appeared relatively calm. Then I saw the blood on the ground around his head. I asked the two guys what had been going on and they stated this guy had been “going crazy” and had hit his head on the ground. My first thought was that perhaps there had been a fight between them and they had been holding him down until the police arrived. He looked quiet enough now. The police officers and my partner walked over so I asked the two guys to get off him. I remember one of them looking at me for an instant as if to say “are you sure?” – then they let him go and stood back. For a few seconds all was quiet… then all hell broke loose.

The guy let out a scream like a banshee, arched his back and began repeatedly smashing the back of his head into the concrete with one of the most sickening sounds I have ever heard. You could literally hear his skull cracking. For a moment I think nobody could believe what they were seeing – then we all jumped in and tried to stop him. While the others restrained his arms and legs, I tried to hold his head still. With all the blood in his hair his head was impossible to hold – I ended up grabbing a fist full of his hair with one hand and placing my other hand under his head. He violently fought against us and was arching his back, easily lifting the two police officers that were trying to hold him down. My partner ran to get the bed and restraints out of the truck. Then suddenly he relaxed, stopped fighting and was quiet again, lying there like he was looking up at the stars, blinking occasionally but not saying a word.

A few tense moments later and we had him restrained to the bed for his safety and ours. I never like doing that but this guy was clearly doing himself some major harm. We loaded him into the back of the ambulance and I set about trying to take some vital signs. My partner placed an oxygen mask on him and I passed over a pad and bandage for his head which was steadily turning the pillow red. Suddenly and without warning, he fired up again, screaming, kicking and writhing. The two police officers who had been lurking in the doorway of the ambulance piled in and we all struggled to hold him down again. He managed to dislocate his shoulder trying to sit up and get out of the restraints – he was unbelievably strong. Because my hands were somewhat full, my partner notified the hospital, which was only a few minutes away, to warn them we were coming. He went from perfectly calm to berserker mode several more times over the next few minutes until we handed him over at the hospital. A few minutes later and there were six security staff, four nurses and several doctors all struggling to manage him.

He would need to be sedated, restrained and closely monitored for many hours until the methamphetamine was out of his system and they could work out how much damage he’d done. When I finished writing my case notes, I went out to where my partner was still cleaning up the blood in the ambulance. Not long after, the two police officers walked back outside. I thanked them for their help, we bade our farewells and we all drove back out into the night. Only another six hours of nightshift to go.

In the way..again.

2007-03-11T20:27:00.000+11:00

We were in a supermarket yesterday. We were in aisle 3 to be precise, treating a patient who was now post-ictal - that basically means he'd had a seizure and was now in the recovery phase which can take quite some time and be quite distressing for the person. I have never personally experienced a seizure but I know from the many I have seen, they can be devastating to the person who does experience them. One minute they are waltzing along, ticking the frozen peas off the shopping list and ..bamm! The next thing the person may realise is that there are strangers standing over them, someone is trying to hold an oxygen mask over their face, they have possibly soiled themselves, they feel really irritable, nauseous or distressed and they are confused and frightened. A pretty ordinary way to wake up in anybody's book.

Yesterday while I was trying to assist this man through his post-ictal period, I'll admit it - I was in everybody's way. Traffic was backed up in aisle 3 all the way to the end of the refrigerated cabinet. Nobody could get through and they had to go ALL THE WAY ROUND to the next aisle to get what they needed to fill their trolley. So to all those people who tut-tutted, sighed and muttered cause you couldn't get past me and my crewmate and the selfish bloke lying on the ground with his head resting on pillow - A pillow! I am sorry we screwed up your shopping experience. I have since spoken to the man an he has promised never to have a seizure in the supermarket again. He will stay indoors from now and make sure he never gets in the way.

To the lady who asked me to pass her the frozen yoghurt, while I was being inconsiderate and taking a blood pressure - I hope you can forgive me - I'm sorry I tut-tutted, sighed and muttered at you. Really I am.

Waiting

2007-02-25T23:31:00.000+11:00

The old guy had been sitting on a seat in the airport arrivals lounge for most of the day. Eventually late in the afternoon he came to the attention of the airport staff when one of the thousands of people who walked past noticed that he had wet himself. The airport staff had then approached him and found him to be confused and unable to tell them much at all. We got called and asked to come and check him out.

We were met by an airport manager who escorted us to where the man was still sitting. He was a little Caucasian man about 70 years old who could have been anybody’s grandpa. He was sitting there with his eyes closed clutching a small leather toiletries bag. My partner spoke to the manager while I assessed the old man. He opened his eyes and tried to answer my questions but was clearly confused and disoriented. Physically he checked out fine – blood pressure, heart rate, lung sounds all normal. I then checked his temperature and blood sugar levels and found them to be normal as well. He didn’t seem to be overly dehydrated and I could find nothing amiss – other than the fact he was very confused.

My partner told me they had figured out from his boarding pass that he had come in on a flight from Indonesia early that morning on a one way ticket. But why was he still at the airport? Wasn’t someone coming to pick him up? He was clearly unable to look after himself and had no idea how he got where he was or where he was going. He was simply just sitting. Waiting.

I asked him if I could look inside his bag and he nodded. Inside I found some basic toiletries, a toothbrush, a shaver and an old bottle of prescription tablets that I didn’t recognise. There was also an old wallet. Inside there was no money, only a few scraps of paper and a photo of him taken years before with his arm around the shoulders of a smiling Indonesian woman. One of the folded bits of paper contained a name, phone number and an address way out in the eastern suburbs, all written in shaky writing as if a child had written it. I handed it to my partner and we decide the best thing to do was to call the number. We had nothing else to go on.

We walked a short distance away to the service counter and the girl there passed me a phone. I dialled the number with my blue gloves on. The call went basically like this:

Hello?

Hi my name is Rob… I’m an ambulance paramedic…..

…yeah?

I’m here at Tullamarine Airport and we have an elderly gentleman here by the name of Norman Smith….I’m just wondering, do you know him?

….you what?

We found your number in his wallet and we were wondering if you can help us work out who he is?

He’s here ….in Melbourne?

Yeah, Are you a relative?

…He’s my… he’s… Look we don’t want nothing to do with him ok.

We’re just trying to find out where he is supposed to be staying so we can make sure he’s alright….

Look he left us a long time ago to be with her and none of the family wants anything to do with him... alright?

Is there someone that he lives with here in Melbourne we can contact?

Mate you don’t get it – he lives in Indonesia. We don’t want nothing to do with him.

The phone was left beeping in my ear. I was stunned. I looked over at the old guy sitting on the chair and told my partner what I had just heard. I could only assume that this guy for whatever reason had left his life in Australia and gone to Indonesia to live with a new partner. His family had apparently never forgiven him. Now he was old and confused, and someone had put him on a plane and sent him back to Australia.

We had no idea what to do with him, so we loaded him up and took him to hospital. I told the story to the triage nurse. They sat him on a chair in a cubicle and made some calls of their own while I wrote my case notes up. The nurse told me she had been given the same story when she called the number in his wallet. Nobody wanted anything to do with him. Whatever he had done, I looked at him sitting there alone in the chair and I felt genuinely sorry for him.

Chain of events

2007-02-19T09:08:00.000+11:00

Over the past few days here in Melbourne emergency services had some difficult, tragic and hard to believe jobs. To top all this off its been really hot and people have been behaving like idiots, some tool has been running all over the place setting fire to the northern suburbs, and people are still driving on the roads like they are invincible. The news this morning again shows that they are not with another car slamming into a tree killing a teenager and seriously injuring sever others.

One of the jobs from the last few days really got me thinking - not only for the families and people involved, but also for the poor crews who had to attend. Two days ago there was a minor reversing accident involving two cars. The driver of one of the cars got spooked and accelerated instead of hitting the brakes. The car sped across the road, over the footpath and slammed a poor young woman against a building, crushing her so badly that she lost her leg. If that wasn't tragic enough, a few hours later the glazier who had been dispatched to repair the damage to the building after the accident, was hit in the heart with a nail from a nail gun he was using. The same ambulance crew were dispatched back to the scene and got him to hospital but he died shortly after, despite emergency surgery.

I just got thinking how strange it is that a minor accident lead to several families having their lives changed forever. I'm sure these ripple effects happen all the time, it's just rarely are they so obvious.

Ecnalubma

2007-02-08T16:17:00.000+11:00

When I sleepily wheeled the stretcher out from the hospital early the other morning there was a little kid standing, looking somewhat quizzically at the front of the vehicle. At first I thought he was mouthing an incantation at the ambulance - perhaps back at the coven, his mother had taught him a protection spell and he was now kindly putting it on the ambulance so we could get home in one piece, without getting another job on the way back to branch.

Anyway, he appeared to be trying to pronounce the funny word written on the front of the ambulance. When I said hi, he got all self conscious and ran off towards where I noticed his mum and siblings were standing. He proudly yelled to his brothers and sisters "It says EKNALUMBA!". I checked and saw he was almost right - then while I was making the bed, I was trying to work out what his pronunciation would have looked like when it was written the right way round. My partner came out and found me standing at the front of the ambulance apparently mouthing strange incantations at the truck. Of course then I got all self conscious.

If you look really closely, you can see me reflected in the bottom right corner of the pic looking tired as the sun comes up over the Northern Hospital carpark. There is even a tiny thought bubble that is me praying we don't get pinged for a job on the way home...

Sheesh!

2007-02-08T16:16:00.000+11:00

If you are going to ride a motorbike - please wear shoes.

Back to it.

2007-02-03T14:07:00.000+11:00

Well I had a little time off away from the blue and red flashing lights and it was good - I have decided holidays are very nice and there should be more of them. Its amazing how you think you are doing just fine at work until your holidays are due and then suddenly the week before annual leave, it dawns on you just how tired you really are.

I was tired - that cumulative tired that can't be fixed by one good nights sleep. I wasn't waking in the middle of the night with dreams of people chasing me down the street, waving their pension cards or anything, (although that was a reoccurring dream last year) I was just getting grumpy on nightshift and running a little low on empathy, sympathy, patience and all the good stuff.

The batteries are now recharged and I leapt* back into work feeling like new. By that I mean I felt good but I also felt like I was a new student again. I couldn't remember all my routine questions and found I was stumbling around for the first few days. It's all coming back to me slowly.

Mostly normal stuff since I got back. A few jobs stood out:

The pissed young moron on his way home from the pub who had been kicking the glass walls of each bus stop as he passed until it broke - eventually his vandalism spree was halted when he got his foot stuck in a trellis fence that he tried to Kung Fu kick as he went past. Lots of pain, a little blood and a very tired left leg from trying to hold himself upright until we got there and freed his other leg. Very very funny.

An old fella standing on the street with a beer in his hand who calmly said his heart was playing up. He was placed on our cardiac monitor only to find his heart was romping along at about 160 bpm. Add to that the fact that he had aching central chest pain and he was sweaty and pale and it was; Off to hospital for you sir. His response: "Can I Finish me beer?".

The old woman who said she hadn't left the house in 3 years - who took so long to get organised to go to hospital that I thought we were going to be there for 3 years as well.
Get me this, lock that up, no - not that one!, what are you stupid?, put the dog out, turn that light off, I want the other nightie, I'm not leaving yet, call my daughter etc etc... Oh and for those of you that think you should be able to exercise a little scene control and say don't worry about all that, let's just go to hospital - just try it with a stubborn old irish lady with a short fuse. She was leaving on her terms or not at all.

* That's for you KimtheVet :)

APGAR

2007-01-24T11:38:00.000+11:00

Well I had another baby. Not me personally :) but I was there in the thick of it with my catchers mitt on. We got dispatched to an imminent delivery (yeah right, here we go - they are almost never "imminent") at about 10 am and we arrived to find mum bearing down hard and dad looking worried. All thoughts of scooping up mum and making a dash for the hospital evaporated when I could see the baby's head beginning to crown. I'm thinking; oh crap I'm not ready for this! I thought briefly about asking mum if she'd mind hanging on for a few minutes while I got my head organised, but no, this was happening right now. I put on my gloves and my bravest face and leaped into the fray.

Well I'll spare you the detail - but about 4 minutes later we had a healthy little girl who very soon began to scream her lungs out - the single greatest sound you can have when you are delivering kids. Its magic! Mum was fantastic and was really clear about how she wanted things done - dad was still looking worried and I tried reassuring him that both of his girls were in good shape. ABC's were good. We then performed the APGAR assessment at one minute and scored her at 8. Excellent. My partner got the truck organised and the five of us were soon on our way to hospital. Apparently they had been caught out with a labour that progressed a lot more rapidly than expected. As we made our way to hospital, mum looked tired, dad still looked worried (I'm thinking that may have been his default expression) and me? I was grinning like an idiot for the rest of the day.

PS I really thought "leapt" was a word but my blog spell checker wants me to use "leaped". Oh well.

Ho Ho Ho

2007-01-08T20:51:00.000+11:00

I worked on Christmas day and instead of kids falling off new bikes, nanna falling sideways despite being propped up at the head of the table and lots of lower 'chest' pain (ate too much) like last year - it seems that what most people got for Christmas was gastro. Everybody was calling in with N and V, V and D, N and D, or just D++++.

The Royal Melbourne hospital has been on gastro alert for more than a week with monitors wearing flouro vests guarding the hallway making sure nobody gets in or out (without washing their hands). Its been a big pain in the backside, with certain sections of the ED cordoned off and crews having to put on the extra protective gowns and gloves just to offload a patient. Merry bloody Christmas..mutter mutter...

I think I may have had gastro for about 2 hours on boxing day, but then again it may have been some dodgy prawns from the night before. Either way I did my best to humanely drown those poor little gastro bugs in a cocktail of local and imported beer. Iron guts 1. Bugs 0.

Anyway, a happy new year to all!

Do you smell smoke?

2006-12-20T21:00:00.000+11:00

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

2006-12-07T19:14:00.000+11:00

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

2006-11-26T19:59:00.000+11:00

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

2006-11-16T13:27:00.000+11:00

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

2006-11-07T13:27:00.000+11:00

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

2006-10-29T20:03:00.000+11:00

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

2006-10-16T22:29:00.000+10:00

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

2006-10-06T23:46:00.000+10:00

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.