gcs14

I'm unconscious - no really.

2012-01-31T22:10:00.001+11:00

People pretend to be unconscious for all sorts of reasons. I've been to countless numbers of patients who for one purpose or another are pretending they are out for the count. I call this being funconscious because its not serious. There are some classic scenarios we see regularly - like the argument or domestic dispute that results in someone taking a little break from the day, the shoplifter whose booty stuffed handbag got the attention of store security, the drunk person who has sobered up just enough to realise that they made a complete fool of themselves and now have vomit in their hair and no taxi money. The bloke at the airport who just got told he’s missed his flight and now collapses to the ground with some bad fake seizure activity and then the usual eyes clenched shut, I’m really, really unconscious stuff follows.

You end up getting a good nose for picking the real deal from the Oscar winning performance. You get no points for picking the bloke who has flown through the air over the bonnet of the car and now has a head like a dropped watermelon. He will almost always be the real thing. It’s the unconscious person in the absence of all obvious reason for being unconscious that is where it gets interesting. There are a number of mnemonics in ambulance for remembering the broad groups of reasons people might be in an altered conscious state or unconscious. What these mnemonics show is there are literally hundreds of possible and potential causes. So we always default to the possibility that this may be real even when we know its not. There that should keep the do-gooders quiet.

I've been to little kids who "wouldn't wake up" who just turned out to be so heavily asleep that even picking them up out of their cot, gently shaking them and taking them out to a bright lounge room full of anxious new parents didn't phase them. I wish I could sleep like that. I can even kinda sympathise with grandpa who was so sick of his wife's constant nagging that he went to his happy place.

There are a few of things you can do to check for purposeful movement (which I wont go into here) and needless to say that the body's involuntary responses and reflexes will often undermine even the most determined efforts on the part of the prostrate (note the subtle but important difference in spelling) punter to stay unroused.

There are stories in every city of those who are true masters of the funconscious episode. These are the ones that everybody knows are putting it on. They are the repeat performers, the true Oscar winners who despite every trick in the book including painful stimulation and invasive airway manoeuvres that would make most of us gag and bring up lunch, are able to lie there and not give the game away. These are the ones who will suddenly recover at hospital, demand the toilet and tell the nurse to give them back their smokes. We sigh and say to each other – I knew she was faking it.

I always give people who are faking it the opportunity to ‘wake up with dignity’. There are always those people who have had such a crappy day that they are now lying there wishing very hard they were somewhere else. Whether you agree with it or not, these people do deserve an opportunity to muster some strength to re-face the day. Give people the opportunity to “recover” with their composure intact and they will often do it without vigorous prompting. There is a risk if you make people feel and look foolish that they will not respond well.

I remember an unconscious schoolgirl who was being teased in the playground and had fallen over in front of her tormentors. The concerned staff couldn’t wake her and the growing crowd was only making it worse. We cleared the area of kids and teachers and whispered to her that it was ok to wake up now. Amazingly she did.

Well, I'm off to become unconscious now for at least the next 8 hours...

Hey there newbie!

2012-01-10T12:51:00.001+11:00

Dear Student Paramedic,

A sincere welcome to your new career as a paramedic. You are commencing on a journey that is like no other. You will know within weeks of starting 'on-road' if this job is really for you. You will know this because your expectations will either quickly be met or left wanting. This job is rarely what people expect it to be. Mostly it is better. You will hopefully be one of the ones who is pleasantly surprised at what you find. This job will challenge and test you like not many other jobs can.

I don't know you, and the reality is we will probably never meet, but allow a crusty ambo to dish out a few words of advice:

Come along with an open mind. Leave your distain at home and bring your sympathy, empathy and understanding.

You will get back what you put out. If you behave like a twat and give people attitude, you will get attitude back. It happens, every time.

Treat every patient with the respect they deserve.

After you have been in the job for 15 minutes, you don't actually know it all. We love seeing you build in confidence and grow in skill, but you make a fool of yourself if you act like you have nothing to learn from the start. Take the time to learn from those around you - learn how things are done. Then you can see how things might be done better. Once you have been at it for a while - please question everything. That is how change happens and that is good.

When you have been in the job for a few years, try and remember what it was like to start on road - find a student paramedic and help them in a way that you would have appreciated when you began. We all know its daunting when you first start. That fear you have will subside.

If you are wrong - admit it. If you make a mistake, 'fess up and learn from it.

If you find this job is not for you and you don't enjoy it - that is nobody's fault, don't take that out on the patients or your colleagues. Go and find something else to do. There is a job out there just right for you.

Have a laugh. This job is actually very funny a lot of the time. So strive to be the best you can and enjoy it as you do.

So good luck, I hope you do enjoy it and stay safe out there.

Cheers.

Christmas Spirit

2011-12-23T14:45:00.006+11:00

Ah, Christmas is upon us once again. Oh Joy. I could write about the rampant consumerism or the dog eat dog, me first performances at the store checkouts. But I won't. I could write about the two women we attended in the shopping centre car park on Thursday who had ended up in a hair pulling, hissing, tangled heap on the ground until the security guards pulled them apart and tried to ascertain who actually saw the empty car parking space first. These women would now have scratches and bruises to show off to their kids over the Christmas dinner. Hey mum pass me the gravy and tell me what Christmas really means to you. Or the guy at the police station who had now suddenly become "unconscious" after being told that being 3 x over the legal blood alcohol limit was "not kewl", oh and trying to outrun a highway patrol vehicle in your Kia hatch was genius, pure genius. On a positive note, the police sergeant did seem to be genuinely amused at how much faith this guy had in his little piece of South Korean automotive history. I was also amused at his attempts to not fall off the chair and hit the floor while being "unconscious". His miraculous recovery after being told he was going to lose his licence regardless of whether he stayed "unconscious" or not, was simply a Christmas miracle. I could write about many of these things, but I wont. Because I am determined that all those mean spirited, selfish people out there are not going to dampen my Christmas spirit. I have a box of shortbread on the dash of the ambulance, some tinsel on the grille and a big smile on my face.

Have a good and safe Christmas all.

Unrestrained selfishness

2011-12-08T18:56:00.008+11:00

From 3 pm to about 4.30pm is I believe one of the most dangerous times to be on the road. Especially around schools. Mums and dads and carers and grandparents and siblings and friends all rushing to get to school to pick up the kids, all running late, all distracted, all worrying about everything except driving.

So today right about the time the school bell sounds, we got sent as the closest available car (yes dual car response was cancelled way earlier in the day) so its just us to a car accident. A car has made a right hand turn across two lanes of traffic and got collected by a vehicle driving up the inside lane that "came outta nowhere". The driver was ok and was immediately telling us he had not been able to see past the mini-bus that was in the middle lane - but had gone blindly across anyway. I have to admit I was not really that interested in what he had to say. It was hot and it was his 4 year old son who was still sitting in the front passenger seat looking small and scared that had my interest. His passenger door had taken the full impact and nobody seemed to be paying him any attention.

We spoke to everyone involved and then asked if we could please have anther ambulance to transport the driver of the other vehicle who had some muscular neck pain. After a long pause - long enough for me to mutter to myself "its not that hard a question is it?!" the dispatcher finally and reluctantly offered us a car from about 20 minutes away. Yes please, that'll have to do. Thankfully the little boy was ok, he was only shaken but I wanted him checked out at a hospital anyway. I offered dad and his son a trip to hospital but he insisted he would get his wife to pick them both up and then head straight to the hospital. I gave dad a lecture about the danger of putting small kids in the front seat of cars, especially with airbags that are designed for adults. He mumbled some excuse at me and went back to ringing his wife.

The other ambulance arrived and we handed over the driver of the other car to the ALS crew. We pulled the ambulance off the main road and completed some paperwork while waiting for the wife to appear. Dad and son sat in our ambulance in the air-conditioning while the police arranged a tow truck. After a while a black Ford pulled up abruptly in the side street behind us. I got out and went to reassure the presumably anxious wife that her 4 year old son was ok. Neither she nor the 2 other primary school age kids in the car were wearing seatbelts. I was incredulous. Then when her first question was about whether her husband's car was still drivable, I was angry.

Ignorance is bliss

2011-12-01T18:46:00.003+11:00

Yesterday while looking for the Christmas decorations, I found a box of faded ECG strips in my garage that I had collected when I was a student paramedic. I remember that I kept many of them at the time because they looked "unusual" or "funny looking". Looking at many of them now (with just a little more knowledge and experience behind me) and I find myself wincing and thinking how blissfully unaware I was of what was in front of me at the time. All the "What ifs" that now race through my head when I look at these old bits of paper... yikes!

Same old thing

2011-11-07T14:25:00.002+11:00

I went interstate on my days off and ended up catching up with a couple of "ambulance drivers" from another state. The uniform is a different colour but the call-outs are the same. We drank coffee and they matched my massive catastrophic shaving cut story with the "not brave enough to pull off own band-aid" story. We went back and forth knowing the saddest part about a bunch of paramedics telling stories is the complete lack of need to embellish. Its the same all over the world.

A voice in the dark

2011-10-22T03:57:00.003+11:00

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?

Heavy eyelids part III

2011-10-17T20:58:00.006+11:00

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.

Heavy eyelids part II

2011-10-16T13:48:00.000+11:00

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.

Ambulance service (Still) in Crisis

2011-10-14T17:03:00.004+11:00

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:
http://tinyurl.com/63rgl2c

http://tinyurl.com/6l65h5r

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.

Heavy eyelids part 1

2011-09-29T18:53:00.000+10:00

"Are you coming mate...?"

I'm suddenly Awake. Confused. Disoriented. My colleague is standing in the doorway of the bedroom waving the radio at me. Oh What!? It is 5:30 am or thereabouts and I had slept through the pager going off for the first time in my career. I mumbled an apology and sat up to pull my boots on. I looked around the floor in the gloom and couldn't see my footwear.... ah there on my feet already, I hadn't even taken them off, just too tired I guess. We had been run off our feet all night and had finally made it back to branch for our half hour meal break. I was so tired, I just had to close my eyes for a few minutes. I was glad it wasn't my turn to drive.

I walked out to the garage where my partner already had the truck running and had been clearly waiting for me to haul my butt out of bed. "You ok"? he asked. "Yeah, sorry, just bloody shagged, didn't hear the pager". I squinted at the data terminal (MDT) on the dash, we were going to a 72 year old female in respiratory distress. My partner informed me he had not yet spoken to the dispatcher who was busy trying to dispatch a number of other jobs to other tired sounding crews. Finally it was our turn and the voice who sounded annoyingly awake and efficient said; "thanks for your patience, at the request of the crew on scene, could you head over to Footscray for a patient with breathing problems. They'll come up with a SitRep shortly."

A few minutes later, the crew gave some brief details about the patient's current state. The voice on the radio sounded elevated and stressed. Hmm this one might be sick. We were only a few minutes away by this stage and told them to stay put and not try and load the patient until we got there. I forced my eyes open and blew out an exaggerated breath in an attempt to clear my head. Going to need to be awake for this one...

Roid rage

2011-09-12T14:20:00.005+10:00

You're an adult male. You seem reasonably "normal". You got up during the night to go to the toilet. As you shuffled down the hallway, I know you were a little hazy, believe me I know. It was sometime in the hours before dawn. You squinted when you turned on the bathroom light. It's annoying when you have to wake up isn't it? A few minutes later as you sat there, staring down at the red dot on the toilet paper in your right hand (or was it your left?), there was a decision point. This was your moment. Your chance to step up....

But you picked up the phone and called for an ambulance.

When we arrived, you explained you had suffered from hemorrhoids on and off for years, you showed us your range of ointments and your little cushion, you explained 'they' had bled before. Your level of detail was as excruciating for me as your "delicate problem" apparently is for you.

Thank-you for saving the fold of toilet paper as "proof" that you weren't kidding. I believe you, really I do. I believe they are annoying. I believe they are painful. What I also believe is; you don't under any conceivable circumstance, need an ambulance for an irritated hemorrhoid.

Grrrr.

Taxi vs Pole

2011-08-08T12:49:00.009+10:00

It is 05:00 am and we are driving back from hospital when we come across a traffic accident. A taxi has failed to negotiate a gentle curve in the road and has struck a power pole. There are no other emergency services on scene and we have not heard any ambulance vehicles being sent to this crash. I get on the radio as we do a U-turn and ask the dispatcher to create a "field event" for us. This can be loosely explained that if we don't have enough work given to us over the radio, we can simply drive around and find our own. Seriously though, any time we get waved down by someone on the side of the road or nanna drops a can of Chunky Beef soup on her foot at the shops while we are trying to buy lunch, we make a field created event that then runs like a normal job.

For a suburban street this is a reasonably big hit. The taxi is twisted out of shape and the power pole has clearly made it nearly all the way through the engine bay to the firewall.

When we look in the vehicle, it's a mess. There is no obvious blood and nobody in the front or back seats. I always check the floor too, as people can end up in all sort of odd place in a crash. All the normal taxi stuff that has been carefully stuffed down between the seats, in the glove box, tucked up in the visor or stacked in the console has gone flying and there are bits of debris and food and paper and CDs and beads everywhere. The mandatory dashboard statue is nowhere to be seen but a resilient blob of Blu-tac shows where it once stood. The airbags have gone off and there is a fair bit of intrusion into the footwell on the passenger side. More telling for me was the evidence outside the car. No skidmarks on the road and major damage to the wooden power pole at about head height. This car was airborne after hitting the concrete curb.

A female taxi driver was sitting on a low brick fence talking on a mobile phone and I went over. After a quick assessment, she's alert, apparently uninjured and doesn't want my help thanks very much (not what she actually said). The driver claimed to be at the end of her shift and said she had "lost concentration". I wasn't overly happy with this. In this area women generally don't work the nightshift on taxis. Especially not youngish, 60kg ones. Yeah yeah before you start, I know there are exceptions to everything. Her taxi company shirt uniform was too big for her and neatly pressed. It just didn't have that I've been driving around for 10 hours, soaking in my own sweat and KFC grease look about it. She just didn't look to me like she had just worked a long shift dealing with customers, fallen asleep, got a yellow taxi 5 feet off the ground and been woken after meeting a solid object at high speed. The police arrived and the first thing she said to them was "I was driving the taxi". Allowing she was the only one on this windy, cold, roadside wearing a taxi uniform the police officer gave her a look that said it all.

I have seen many accidents where the car is wrecked and the people inside are fine, but I've also seen the opposite, where the car looks fine and the person is critically injured, so there is no sense in trying to predict patient outcomes on how interested Neville the claims assessor from the insurance company is going to be. After persisting, I persuaded the driver to go to hospital for a check-up, but despite careful looking, I found not a scratch on her. No seat belt stripe (the tell-tale diagonal red bruising), no back or neck pain, no glass shards in her hair, no cuts on the hands or pain in the chest. Vital signs all within normal limits. The hospital checked her over, and then did it again after looking at the photos my partner took of the crash and found nothing wrong either. She was collected by a relative from hospital before I had even finished my paperwork.

Hmm.

Stand by

2011-08-05T15:57:00.002+10:00

After a long absence, and a lot of kind emails I've been persuaded to write some more.

Stay tuned...

Cheers,
Rob

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.

Dominos

2006-09-28T23:18:00.000+10:00

I work in the city, so incidents involving livestock are pretty rare. When we got dispatched to an old man with a suspected broken leg following a fall, I thought it would be fairly straightforward. We were greeted by his wife and daughter and led to where the man was lying on the couch at home. As we walked down the hall I asked what was happening today – sometimes you can get a few quick details from family members as they take you to the patient. His daughter just said he speaks mostly Italian, but she would let him tell the story. For a moment I thought she appeared to by trying to stifle a laugh, but I dismissed it as I walked into the back room.

Our patient was a fit looking older fellow with a thick accent, but his English was substantially better than my Italian. He was smiling and greeted us warmly when we walked in. I asked what had happened and he said “well…” and the vigorous arm waving began, “well…you know that bloody cow?”. For a second I was worried he was talking about his wife who was hovering nearby. His daughter must have seen the look on my face and began explaining that her father and mother had a small farm on the outskirts of Melbourne and both had been up there today fixing a fence. I asked again what had happened and was told by our patient that he had been working on the fence when ‘that bloody cow’ had stepped sideways and bumped into him. “Ah and that’s how you hurt your leg?” “No” all three of them replied almost at once. “The cow… he hit me..and... I hit the sheeps” Lots more gesticulating. Hmmm. I needed clarification.

I turned to his daughter who by this stage was unable to contain herself and told me the full story. Her dad had been knocked sideways by a cow he owns, who it seems sort-of nuzzles up against people, and he had then fallen over one of the sheep who was also crowding round thinking it was going to get fed. Her father had gone down in a heap on the ground injuring his leg. While we assessed him, I asked a few more questions. “So your wife then drove you home and you rang an ambulance?”, “No she is no good driver, I drive”. “You drove?!”. It turned out the farm was over an hour away - a long way with a broken leg.

I enquired about his pain level, and he waved me away dismissively saying he was alright. I looked at the increased heart rate on the monitor and the beads of sweat on his forehead and decided to try and make him a bit more settled. He had a probable fractured leg that would make most of us weep and he was being stoic. Tough old bugger. When he was loaded up in the ambulance and away from his family I again offered him some pain relief – I was glad he agreed and was soon a bit more comfortable. I joked with him on the way to hospital; “So what are you having for dinner tonight – the cow or the sheep?” He just said; “Pasta, she always make pasta”.

Now I lay me down to sleep

2006-09-24T07:38:00.000+10:00

Hey firstly thanks for all the great comments lately everyone, you have made me laugh several times!

I've just completed a Saturday nightshift. My eyes are burning and I feel slightly nauseous from lack of sleep and too much coffee. It was a flat out night, 15 hours with just a 30 minute break early in the night where I managed to grab a meal. I was lucky, I heard many of the cars still reporting they had not eaten a meal late into the night. The city hospitals were struggling and the ambulance service was running around all night, chasing all sorts of calls until the morning finally arrived and it died off a bit. There are a lot of very tired paramedics out there this morning.

My partner and I did no really major jobs of note, just an assortment of miscellaneous calls - a regular caller who is a chronic alcoholic and has taken to ringing for the most rediculous reasons, an old girl in a nursing home with a fever, a drunk young man with laceration to the leg, a man with angina, a man who had been assaulted the day before and now had two black eyes, a woman with anxiety, another woman hyperventilating, a man with abdo pain and a girl with a sore throat, oh and a kid who had fallen out of a high chair.

All in all a big night. But now I am bone tired and need to sleep. I have a few good stories to tell but they will have to wait until I'm rested. Eyes are getting heavy...

Let the snoring begin.

Give me strength

2006-09-17T12:16:00.000+10:00

Patient: Me foot hurts

Rob: How long have you had the plaster cast on it?

Patient: Free days

Rob: You broke your ankle?

Patient: Um.. I fink so.

Rob: ...you think so?

Patient: Mate I don’t know – I don’ remember.

Rob: Have you been taking any pain relief medication for it?

Patient: Nah.

Rob: Any reason why not?

Patient: I haven’t got the script filled yet.

Rob: er...why not?

Patient: I dunno.

Rob: Has it been hurting since you broke it?

Patient: Yeah but it’s been getting worser.

Rob: Have you been walking on it?

Patient: Nuh

Rob: The bottom of the cast is pretty black and worn out, are you sure you haven’t been walking on it?

At this point Rob’s partner holds up a cigarette butt he’s just found stuck to the base of the patient’s plaster cast

Patient: Just down to the shops an’ that.

Rob: (Sigh)

Patient: It hurts

Rob: So you broke it 3 days ago, have been walking around on it and now it’s sore?

Patient: Yeah

Rob (getting frustrated): Any reason you didn’t get your prescription filled when you went down to the shops?

Patient: Um…I didn’t think about that...

Rob’s partner (getting frustrated): …but wasn’t your foot hurting?

Patient (getting frustrated): Yeah. Look mate, I wanna go to hospital.

Patient then walked out to the ambulance

Chomolungma

2006-09-13T13:47:00.000+10:00

It’s funny the conversations you have in the wee small hours of the morning. Driving back from hospital along the freeway with my work partner we’ll sometimes find ourselves talking about the most bizarre things. Last night we discussed wind farms, the mighty Pavlova, roof guttering, ….oh and the guy who’d just tried to chop his man bits off with a knife because his previous attempt at dropping a television on it hadn’t quite achieved what he was after.

If you are confused by that, you are not alone. When the crew who just brought him to hospital told me the story, I had nothing but questions. Lots and lots of questions. The main one was why? But I have no answers for you, sorry.

Like me you will just have to settle for the Mount Everest explanation: Because it’s there.

Shakes on a plane

2006-09-02T15:07:00.000+10:00

We went to the airport again and got to go on a very big shiny plane. I love it. We drive out onto the tarmac and the planes seem so much larger when you park beneath them. It’s windy, cold and very loud. The unmistakeable smell of jet fuel is carried on the wind. We head inside and up some stairs to the gate lounge. It’s so much quieter inside. A pack of us stand there silently waiting for the plane to taxi to the gate. The airport people, the airline staff, the customs people, the quarantine officers and a couple of paramedics with their bags – all with their jobs to do, all looking pale and sickly under the fluoro lights of the gangway.

The plane door eventually opens up. The well-tanned flight attendants say good evening and still manage to smile even though I know they have probably been doing it through gritted teeth since they left LA, Singapore or Dubai or wherever it is they have come from. The flight staff tell us they will wait for our all clear before moving people off. We walk on past business class, into the cabin and 200 faces look up. The quarantine people are anxiously waiting for us to tell them that we don’t think its something nasty like SARS or Bird Flu. Who knows what they’d do if we thought it was – perhaps tow us back out to the middle of the runway and leave us there to fend for ourselves…

I work my way down the rows towards row 26, bumping my bags into chairs, people and fittings. Sorry…excuse me…Row 22, 23, 24…..its going to be a window seat. It always is. People are standing in the gaps between the rows, cabin luggage in hand, anxious to get off. A young girl is curled up against the window with her knees drawn up. She peers out from under her hair and I can see she’s been crying. I ask the person holding her hand to move out and talk to my partner while I slide in to the seat next to her. At least I can say I sat on a plane even if I didn’t actually get to fly anywhere. For a brief moment I realise how much I’d like to be flying back from somewhere warm.

The girl’s English is poor and I take a second to understand her accent and sentence structure. It’s weird like that, I find you sort-of ‘tune in’ to the way people talk. I can overhear my partner talking to the crew and she’s being told; “…the girl was shaking violently during the flight…they though it was a seizure….is she going to be ok?...we gave her some oxygen”. I do a bit more of an assessment and see that the girl is still trembling. I can see she seems in no immediate danger and I give the flight attendant the go ahead to move everyone off the plane. We don’t need to get off in a hurry and in a few minutes it will be a lot calmer and quieter in the cabin. The quarantine person taps me on the shoulder anxious for my opinion. I quietly relay to him that I think it might be an anxiety issue. He seems happy with that and goes away writing something on a clipboard. The people begin to file off the plane and I notice with some amusement that the same rubbernecking behaviour we see with car crashes happens as the passengers shuffle past us down the aisles.

The girl turns out to be older than she looks and is travelling with her parents who speak no English at all – we struggle to find out much information from them. I turn back to the girl and she has begun to violently shake again. I can see why the flight attendants were a bit freaked out. She’s shaking, but it is clearly not a seizure. I hold her hand and get right in her face while we talk. She calms down a bit. The plane empties and we walk her a few steps to where my partner has a wheelchair waiting. I watch the parents as we walk out and see that they are not looking quite as concerned as I would expect – I figure they have seen this before. I give them a reassuring smile but it seems to have little effect.

We head down in the lift to ambulance and all climb in. I start my assessment again from the top. I want to be sure I haven’t missed anything. She starts breathing heavily and the shakes begin again. I catch my partner’s gaze in the rear-view mirror. She looks puzzled – so am I. It looks like an anxiety type episode, but with very little dialogue between any of us, it’s hard to tell. We follow the escort car as it leads us out to the airport gate. The driver waves us on and I hear my partner call out “thankyou” even though the escort guy can’t hear us.

Soon we are on the freeway heading for hospital, me holding the hand of a distressed girl, her mother staring at me expressionless, her dad up front sitting silently as my partner guides us towards the city. I can’t help but wonder what they are all thinking.

Service interruption

2006-08-30T15:54:00.000+10:00

Guys and girls, sorry no posts for a while - I've been off work and off the air looking after a close relative who is unwell. Normal programming will resume ASAHP. Please bear with me.

Thanks,

Rob

Soundtrack

2006-08-21T19:25:00.000+10:00

Quite some time ago "they" (those people who do stuff when I'm on days off) took away our music, by this I mean they disabled and disconnected the CD players in all the ambulances. For a while there we were able to go screaming through the streets with Wagner's Ride of the Valkyries (from the Apocalypse Now soundtrack) blasting from the stereo as we made our approach. Occasionally in our haste to get out of the truck at a job, we'd leave the volume turned up. When we had just got grandpa settled on the bed in the back, and we've helped nanna finally get her seatbelt on in the front, we'd start up the truck and scare the absolute crap out of everybody. I can't imagine why did they took them away.

Now we just have the radio which is wired through the data terminal (MDT) in the truck and has atrocious reception - if you like your Britney Spears with a lot of hiss and crackle (which I actually do) then its fine, but if you really want to hear the cricket score or the traffic report - Tough. A few of us now bring in iPods and transmit through the radio - it still sounds crappy but it does give us a way to listen to something other than moronic talkback at 4 am.

Today I've been making up a playlist to play in the ambulance. I figure I need a good mix of tunes from a variety of artists. I hope I have something for everybody :)

Kanje West - Breathe in Breathe out
Audiovent - I cant breathe
The Police - Every breath you take
Yes - Saving my Heart
NOFX - You're Bleeding
The Replacements - Take me down to the hospital
Bob Dylan - It's Alright, Ma (I'm Only Bleeding)
Boy George - Do You Really Want To Hurt Me
Urge Overkill - Positive Bleeding
Metallica - Kill em all
The Flaming Lips - Mr. Ambulance Driver
Bon Jovi's - Bad medicine
Tori Amos - Taxi Ride
Lynyrd Skynyrd - That Smell
Pearl Jam - Let Me Sleep
The Prodigy - Crazy man
Queens Of The Stone Age - Everybody Knows That You Are Insane
Madness - House of Fun
Mark Knopfler - Don't Crash The Ambulance
Madness - Cardiac Arrest
Golden Boy - Rippin' Kitten ( I feel like takin' a life)
Nat King Cole - Pick Yourself Up
Led Zeppelin - Sick Again
Pink - You Make Me Sick
Blur - Ambulance
Eskimo Joe - I'm So Tired
Alkaline Trio - My Little Needle
Guttermouth - This Won't Hurt A Bit
and lastly..
Frank Zappa - Why Does It Hurt When I Pee?

Well, That oughtta just about do it. Anybody have any others I can add?

Burned

2006-08-14T19:25:00.000+10:00

I've hung onto this story for about a week, not sure if I would post it - but I'll relate it here because it highlights how vulnerable our elderly can be. I think its just about the worst ambulance story I have ever heard. By that I mean the most tragic, horrible and ultimately sad.

I got this story directly from the crew who attended this case last week, so I hope I can keep to the basic facts.

An elderly woman spills something from her stove (probably oil) onto her legs and is engulfed in flames from the thighs down. She attempts to put the flames out with her hands but is unable to. She knows that she is supposed to push the button on the medi-alert pendant round her neck if "something happens", so she pushes it and sits down in a chair. The alert company contacts her on speaker phone and hear her desperately crying out for help. They call for an ambulance. Another nearby person (who I think was a council worker, but I may be wrong) is also notified. He arrives at the house after about 5 minutes, gains entry and finds the woman still on fire. He extinguishes the flames and shortly after this the first ambulance arrives. The crew apply burns dressings to her legs, but there is little point. The woman has effectively burned all the soft tissue away from her legs from the thigh to the ankles. Not much more than bone remains. She is still conscious. A MICA unit is soon on scene and the woman is conveyed to hospital.

The crew later told me they believed she would die in the few days after arriving at hospital.

Many elderly people will stubbornly (and quite understandably) fight to stay living at home, preferring their independence, often long after it is safe for them to do so. Please if you have elderly neighbours, keep an eye on them and maybe drop in and make sure they are ok every now and then.

Nil by mouth

2006-08-14T09:15:00.000+10:00

Normally I bring in my meals on nightshift, that way when I do finally get a break I am not scrounging around the kebab joints and taxi cafes at 3 am looking for something edible, something that will not kill me before the end of the shift. Yesterday we could not get a feed to save ourselves. In the end it became comical. We would walk into a place and before we had even settled on something on the menu - the pager would go off and we would be walking back to the truck...cursing.

Each time we walked in to place serving food we would get a SelCall for a job. The sandwich place was bringing in its tables as we pulled up. The pasta place was flat out and after queuing for whileI gave up. Later I ordered a pizza and cancelled it before it had been put in the oven. Later still I ordered a kebab and then suffered a vicious scowl from the guy behind the counter, despite cheerily saying we'll be back soon. We wouldn't and we weren't. I started looking around to see if we were being filmed for some kind of Candid Camera show - ha ha really funny guys - its midnight and I'm about ready to eat a box of rubber gloves from the truck.

We finally pulled into a service station and I stood there for a bit almost tempted to go one of those pre-packaged bacteria-filled certain-death chicken sandwiches. Normally I wouldn't even consider eating something like this, but my Blood Sugar Level had dropped to well below my mental age and these little guys had the crusts cut off them and all. Fortunately the little voice in my ear that was telling me not to buy them, won out. I guess that's why we work in pairs after all. A bag of peanuts, a fruit juice and a deranged psych patient later we got back to branch. I ate about seven pieces of toast with every different topping I could find in the cupboard. Bless the social club for keeping us well stocked. Exhausted but finally sated, I fell asleep on the couch watching infomercials.

The disappearing patient

2006-08-06T13:33:00.000+10:00

Dispatched to a shooting in the suburbs late in the afternoon. A dual car response with a MICA unit backing us. We were told to exercise due caution and not approach the scene until it was declared safe by the police. Fair call - I am no hero and I am more than happy to wait til things have settled down a bit - specially if there are high velocity weapons involved. The police gave us a location in the next street where thay wanted us to wait. Our patient had apprently been shot at home and the caller was stating the whereabouts of the offender was unknown. We waited and listened intently to the radio, knowing full well lots of other ambulance crews would be doing the same - everyone listens to events like this when they happen - and it can be very compelling listening.

Shortly after we arrived at our staging area, we got an update through saying that police had entered the scene and someone had indeed been shot. Then a minute later another update stating the patient was now no-longer breathing. However the area was still not secure and we were instructed to wait where we were. Oooh, we thought, this was for real. We were discussing that with the delay in accessing the patient and a gunshot wound that stops you breathing, the victim was probably "very irreversibly unwell".

The next few minutes seemed to take for ever as we waited for news. Finally the dispatcher came up on the radio and said we could cancel(!). The police had just advised that there was no patient. What the...?! I'm still at a loss as to how a job goes from confirmed gunshot wounds and not breathing to 'move along thanks, nothing to see here'. Abducted by aliens? Witness protection? You tell me.

Dame Edna

2006-08-03T09:19:00.000+10:00

Many of us who work in the northern suburbs have met Dame Edna. Now I should immediately point out that despite appearences, this is not the real Dame Edna. She/he is a familiar sight at a certain hospital and many of us have picked her/him up. Edna is a colourful character both literally and figuratively speaking who doesn't seem to mind ambos, but really doesn't like hospital staff. So he/she can be nice as pie on the way to hospital and then drives the ED staff mad for the rest of the day. I might have him for twenty minutes. They can have him for their whole shift.

The first time I picked up Dame Edna I was a little shocked. Here was a six foot hairy man (woman?) wearing a dress, the purple wig, stylin' glasses, waving a glowing plastic flower in one hand and a fag in the other. Rumor also has it that he tried several other personas, including a certain superhero before finding "the One". Edna has a nasty tendency to take a lot of a close relatives medication resulting in the need to go to hospital for observation.

Last time we picked her up, she (yeah, I'll just say she, it's easier) ... she had absconded from hospital before they could monitor her blood levels. My partner was a little stunned when she charged out of the house towards us. Fortunately the Dame was in a reasonable mood. We dropped her off, they took blood samples and she had stormed out in a rage, waving her flower and scaring the entire waiting room to death long before I had finished my case notes.

A day in the life

2006-07-31T09:38:00.000+10:00

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

2006-07-24T21:27:00.001+10:00

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

2006-07-19T10:43:00.000+10:00

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

2006-07-10T22:51:00.000+10:00

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

2006-07-05T11:41:00.000+10:00

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.

Parenting Permit?

2006-06-29T11:51:00.000+10:00

Yesterday while driving our ambulance around and looking for trouble, we pulled up next to a fairly new looking car at some traffic lights, two adults in the front and one clearly unrestrained kid of about 3 standing on the back seat looking back seat at us. Being a complete do-gooder, smart-ass, know-it-all, who really can't mind his own business, I wound down the window to politely suggest that a seatbelt and maybe a booster seat would be a good option for the little guy in the back seat. Thats when I noticed another smaller child sitting on mum's lap in the front seat. No it wasn't Britany Spears, sorry. I could see from my high moral standpoint, or as I prefer to call it; the elevated cab of the ambulance, that both mum and child were completely unrestrained too.

Well boy was I set back on the right path - what was I thinking by trying to impose my snooty value judgements on these fine parents? I was given a right royal serving and told to go elsewhere. I was chastened yes, but still I hadn't quite learned my lesson and figured I let the Police deal with it.... 'cause although I had a uniform and some flashing lights and stuff, I was apparently a "wanna-be cop who can't mind his own business". Despite an afternoon phone call to the police, I was outsmarted once again because the vehicle was not even registered.

Just another code 3

2006-06-25T15:37:00.000+10:00

Recently we got dispatched to do a routine code 3 transport. We get to do these when the private company that has the contract to handle these jobs is too busy or is “unable to meet the timeframe” – this seems to happen quite a lot. Normally this means the patient needs to get to dialysis or some other appointment and does not need an emergency ambulance. This particular patient was scheduled by her doctor to go and have a CT scan due to a week of severe headaches. We are usually required to be there within an hour of dispatch – this means you can at least finish your cuppa at branch and don’t exactly need to run to the truck :)

On arrival my partner and I were met at the door by the patient’s husband (who only spoke a little English) who led us to the lounge room where we walked in to find a young woman sitting on a couch, wearing a nightie and being supported by some other family members. I introduced myself and got no response from the woman; she didn’t meet my gaze and just stared off into the distance vacantly. I asked her husband what had been happening today - I already knew we had been called to take her down to her appointment but I wanted to find out a little more. After a long and unproductive attempt at conversation involving several elderly family members I finally resorted to conversing only with the primary school age child who was there. She was able to give me really good yes and no answers – kids are great like that.

It turns out that this woman had indeed had a history of headaches and vomiting for about a week and her doctor had decided it was time to do a scan to try and rule out anything sinister like a tumour or a bleed of some kind. She’d had a baby about 4 months ago and had been in good health since. However she’d been completely non-conversant since getting out of bed in the morning and had been found standing in the kitchen “with her eyes going all crazy” or just sitting on the couch staring like she was now. My partner and I both looked at each other realising that this woman was possibly quite unwell and we would be taking her to an emergency department and not to her appointment. I tried to assess her but she would get really irritated and resistive, letting out some horrible guttural screams whenever she was touched by anybody. I was beginning to think she had possibly had a cerebral event of some sort – that might fit with the recent history of headaches. She appeared to have full use of her arms and legs when pushing me away and there was no obvious facial droop – so the classic stroke symptoms weren’t there. That of course did not rule out anything. As we loaded her into the ambulance I’m watching her carefully trying to observe anything that might give me a clue as to what was happening; stroke? drug use? psychosis?... no sign of trauma… hmm... fake symptoms? hypoxia? metabolic cause? Was she hypoglycaemic?….nope. What was going on here?

With a lot of effort I managed to get a baseline set of vital signs an oxygen mask on her for a total of about 3 seconds, then she rolled onto her stomach on the stretcher and despite repeatedly turning her back over she kept screaming out when touched. She had adequate blood pressure and pulse and was breathing well. Eventually I figured I’d leave her alone and just hold the oxygen mask right near her face – I was sure if she was having a cerebral event then the effort of fighting our attempts to assess her would be doing her intracranial pressure no good at all. Hospital was nearby so it was fortunately a short trip. When we arrived I got that look from the triage nurse as which said; why are you bringing in an altered conscious state patient lying on their stomach? I explained how combative she had been and as the staff tried to help us move her off the stretcher it soon became evident to them too. I left them with a diagnosis of “Sorry, I just dunno” – I guess that’s why we brought her to hospital.

Late in the shift when we went back to the same hospital we checked back to see how she was doing – I was surprised to see she’d been sedated and intubated. They’d done a scan of her head and found nothing, checked her blood and spinal fluid and again found nothing. The doctors were talking about possible postpartum psychosis, but they too were scratching their heads. I came back the next day and again asked if they had found anything. But they had transferred her to another hospital when they found after extubating her she was worse, even more irritated and combative. I really hope she was ok.

That's a negative ghostrider

2006-06-17T10:29:00.000+10:00

Yesterday we got a selcall telling us to head for a small commercial and domestic airport nearby. A plane was coming in and was apparently in trouble with 3 people and 700 litres of fuel on board. It was a small twin engined plane with issues with its landing gear. I straight away (and very professionally) thought Cool this should be worth a look!

We jumped in the truck and headed out to the staging area where we were meeting the other emergency services, thinking we would find a single fire truck and some old guy from the airport telling us where to park. We pulled off the freeway and there was an absolute sea of flashing lights, police cars, fire trucks, airport vehicles, ambulances, managers, about a hundred people all milling around wearing reflective yellow vests. Not wanting to be left out, my partner and I donned (I love that word) our high visibility gear and went to find the commander in charge.

We were told to follow a couple of fire trucks out onto the tarmac area to standby. The plane was going to do a fly-by of the tower to see if the landing gear was down. Fortunately it was, but the lights in the cockpit said otherwise so we were all poised, ready to clean up the results. After circling for a while to dump fuel, finally the plane appeared again and there was a brief tense moment as it touched down when we all waited to see if the landing gear would hold. I'm happy to say it was a textbook landing and the plane rolled to a stop without incident. So I'm slightly bummed I didn't get to see them bury the plane in fire retardant foam, but I'm glad everyone was ok.

We took off our vests and cleared from the job after having a quick chat to some of the other crews there. Almost immediately the MDT let out that sound and we were dispatched to an Unknown Problem - Third party caller. That pretty much says it all. Armed with just slightly more than no information we headed back out into the afternoon.

Green Grass

2006-06-16T08:33:00.000+10:00

Its been really busy where I work lately. Who knows why and there probably is no real reason. I've given up looking for reasons, public events, full moons and weird calendar dates like 06.06.06. That's just the way it is. On the day shifts we've been leaving branch before 7 am and getting back late, often without so much as a glimmer of a meal break. I've been living on muesli bars and diet coke out of my bag in the truck. Really healthy stuff.

On the night shifts it just doesn't stop. Back to branch to re-stock and then out again for more. Its strange when you then talk to some of the other cars who are only a suburb or two away and get told they have not turned a wheel after midnight. I know the dispatchers are trying to maintain coverage, but surely they could drag a couple of the quieter peripheral cars out of bed and get them to take just a few of the jobs, You know, maybe share the love a little?

The upside of this (there is always an upside) is that I've been getting home so tired that I have been sleeping really well after night shifts. Despite being loaded with caffeine I'm managing to sleep all the way through til mid afternoon when my alarm goes off. Although all the stuff I usually get up and do between nightshifts is getting neglected. My neighbour just asked me if I'd like to borrow his lawn mower - do you think he's trying to tell me something?

Rugby

2006-06-15T09:38:00.000+10:00

I took a night off and went to an English pub the other night to watch the rugby. England Vs the Wallabies in Sydney. I figured it would be a bit of rowdy fun to watch the crowd get all worked up as England did the usual and kicked the "wobblies" out of the park. When Australia ended up winning 34-3 there was a fair dampener on the mood. Everyone turned their backs on the TV, started downing even more pints and talking about the World Cup instead. Stangely I woke up with a headache.

Mobile phones

2006-06-11T14:06:00.000+10:00

About 10 years ago I got my first mobile phone. It was a great big clunky thing that ran on a now defunct network. Reception was pretty ordinary but it soon wangled its way into my life, quickly becoming an “essential” part of my every day. I soon developed a kind of pre-flight check as I left the house each day that comprised of patting various pockets and saying out loud “wallet….keys… phone”. Now if I forget my phone somewhere I get the same feeling I used to get if I misplaced my wallet; a brief flash of fear followed by the creeping realisation that if I don’t have my phone, then I’m screwed, how will I get all my numbers back?, no one will be able to reach me!

I vaguely remember my life before I grew that digital appendage, before I became slave to the mobile millstone, but what I can’t picture now is how I actually managed to function without it. Australia has one of the highest uptakes of mobile phones in the world. We can’t get enough of them. Just about everyone has one and it is rare that you meet someone who doesn’t. In ambulance this has changed things - a lot. On the plus side mobile phones have given many people access to emergency services a lot quicker than may have been the case in the past.

Now however, all 25 bystanders at an event will now call the ambulance rather than one person heading down to the nearest phone box, so there may be multiple calls to one event. People driving past an accident (or even past someone asleep in their car) will now call an ambulance without actually stopping to see if one is needed. As a result they can’t give the calltaker any details because they are now 10k away down the freeway.

The biggest change that I see in my little pre-hospital window of time is that carloads of concerned relatives will now get to the scene before the ambulance does and then continue turning up while you are there, often blocking the street with their cars making egress impossible. Just when you have calmed down an already elevated and hysterical scene another car will pull up and it’s all on again. I now often find myself deeply concerned with the wellbeing of the convoy of hysterical relatives following the ambulance to hospital – on more than one occasion now I’ve had to pull over the ambulance and walk back to tell the procession to settle down before they cause another accident.

Mobile phone use is insidious and pervasive. I say this because a few days ago for the first time, I used a mobile phone as an assessment tool, I even used it in my handover to the triage nurse at hospital and she didn’t bat an eyelid. My patient was pretending to be unconscious. She had called her case worker and told him she had taken an overdose, he had done the right thing by his client and called an ambulance to attend and make sure she was ok. She was able to walk and talk just fine at the scene but suddenly in the back of the ambulance she was only able to be roused with a lot of a shoulder shaking and a loud voice… until her mobile phone rang. At which point I think she forgot to be unconscious and answered it – asking whoever it was on the other end to “bring me in some smokes will ya”. Then she ended the call and became “unconscious” again. This occurred a total of three times en route.

On arrival at hospital she was still “unconscious” and triage looked at me quizzically until I explained the mobile phone usage. As I went off to do my paperwork I saw the triage nurse heading into the cubical with a sly grin to protect the “unconscious” patients’ airway with a large nasopharyngeal airway. Let’s just say she was not unconscious for long. I headed back out to the car and the first thing I did was check my messages.

Friday night

2006-06-03T15:30:00.000+10:00

Wow, what a night that just was. Forgive me if this is a little incoherent as I've been awake for about 30 hours now and I'm frazzled (is that a real word?). Shortly I'm going to bed, but I just wanted to write some stuff before I begin drooling unattractively onto my pillow for the next 8 hours.

We got into the heart of the city and saw humanity at its finest as drunken mates brawled with strangers and each other. We did however see a kid having a seizure (it was his first one, so he got to go to hospital for investigation) and had a few patients who actually needed an ambulance.

About a third of my patients last night were in police custody for various reasons. Some had been fighting and had lost, some were PFO's (pissed and fell over), some had been arrested for drink driving and now thought that a theatrical "I'll just throw myself to the floor and pretend I'm unconscious" was going to make the police charges go away. Wrong.

Its hard to pick my favourite job from the last 24 hours...but here are some "honorable Mentions":

The young man who had just taken a big syringe full of amphetamines and was now feeling "jittery" and restless. Newsflash - that's what happens when you pump low-grade poison into your veins. He kept grabbing at me and saying; "You gotta help me - I'm dying". He wasn't and he didn't.

The bloke on the street corner who insisted on being taken right across town to a particular hospital because he had a really bad pain in his shoulder, oh and yeah, it was near his house - who then walked straight out of the ambulance, through the waiting room and went home. Ever heard of using a taxi?

The girl who was so drunk, she was lying in her own vomit and urine on the footpath and whose friends thought that they'd leave her there to sleep it off while they stayed in the pub to keep drinking. I wish I had friends like that.

A particular winner for me was the group of 16 year olds apprehended by the police with a shopping trolley full of household letterboxes they had been stealing - what the hell were they intending to do with them?

Choice

2006-05-30T16:50:00.000+10:00

The other night my partner and I were sent to find a patient who had absconded from hospital during treatment for a life threatening condition. Because she had walked out on her treatment at hospital, and because a doctor believed she needed this treatment to continue living, the doctor had signed papers that turned her into a 'recommended' patient, essentially declaring her unfit to make her own decisions.

I should be fair and say that this is a temporary measure that gives police and ambulance crews the authority to transport a person to a facility for proper assessment by a qualified person and is not a permanent removal of the persons independence. However, I just found it a bit strange that for all intents and purposes this elderly woman was 'rational', had lived with this medical condition for many years and was apparently making an informed personal choice about her treatment. Yet we were directed to take her to hospital, to override her wish not to be treated and utilise police as required to make it happen.

I know some will see this as a passive suicide attempt by this patient, and perhaps it is, but what limits should we set on someone making a personal decision about their treatment? Is it whenever that treatment is likely to cause them detriment? (the medical profession allows people to make dubious health care decisions all the time) or is it whenever that decision may actually cost them their life? I don't know, but it just didn't feel right to me on the night.

Mornin' Rob

2006-05-26T17:37:00.000+10:00

Its 4.pm. For the first time in months I've had a decent few hours sleep after night shift. I'm staring at the pile of cereal I've just poured onto the Kambrook sandwich grill and thinking through my cloudy haze that something doesn't look right. The cat circles around my legs trying desperately to get my attention. I know as soon as I feed her she'll give me the question mark (she looks like a ? when she walks away). It's an odd arrangement. All I'm apparently good for is providing food and a heat source on cold nights. Seeing that I'm off working most of the time I'm not brilliant at providing either.

I check the answering machine and listen to my messages - some of them are 3 days old already. Letting out an exaggerated yawn, I put on a big pot of brewed coffee. It usually takes me a few cups to get a clear head. I jam my nose into the only milk carton in the fridge. It fails the sniff test miserably and I recoil cursing. Scratch about for some coins and walk down to the local shop. People are driving home from work and kids are getting off the buses after school - I feel really out of it - a strange disconnected feeling. The cat meets me at the front gate and then follows me inside pleading for attention. Ok ok! Phew... still one can of cat food in the cupboard. She takes one sniff, looks at me and walks away. Great.

I get four days off. I have just slept through my first one and there is less than an hour of daylight left. I will sit watching tv or reading a book for the next few hours before going for a run. Then its dinner and an early night. The real days off start tomorrow.

The missing piece

2006-05-25T16:34:00.000+10:00

I just completed my first night shift with a nice bloke who I haven't worked with before. We took over from the day crew and were told it had been a 'reasonable day'. Hmm... was that good? Did that mean it was going to continue to be 'reasonable' or did it mean we were about to have one of those nights?

We had a couple of interesting and challenging jobs fairly early in the night. First up we went on a Signal 1 call to a young girl of about 18 months who was in apparent respiratory distress. We arrived and found a very cute girl with beautiful black curly hair and huge eyes clinging onto her mothers leg in the hallway. I just re-read that and yes, the leg was still attached to her mother.

As with so many of the families where I work - nobody spoke much English. Sometimes there will be a very young family member who has been educated here in Australia who can act as translator for you. This is usually a great way to get answers, although often you need to be very strict with your questions because you will ask "Does your mum have pain in her chest - yes or no?" The kid will turn to mum, there will be a 4 minute long conversation and the answer will come back "she is sick, she doesn't feel well, she doesn't like going to hospital...". Utilising the kids is often your only option and can provide its own curly issues - asking a 7 year old to help ascertain if his mother's waters have broken can require some dexterous verbal gymnastics.

Anyway where was I?... ah the kid and the leg. It turns out she had been "breathing funny" when she was down for sleep. She had been treated with antibiotics about 2 weeks ago for a chest infection but according to family it was gone now. We did a really thorough assessment of the little one and found the only thing amiss was a slightly elevated temperature. She had clear lungs, good heart rate and respiratory rate, she was active, happy and reacting appropriately to mum and everyone around her. But mum was insisting she was sounding strange when she was in bed so we stuck around to observe the girl while my partner did his paperwork. Everything checked out, but as always with kids, we offered mum a trip to hospital for a check up. She declined so we suggested that she take the girl to her local doctor - and she agreed. Hmm... but what were we missing?...

We packed up our stuff and I stopped playing with the kid and helped carry bags out to the car. We were just going through the front gate when there was a single barking sound from the house behind us. Aha! the missing piece of the puzzle. The seal-like barking cough that comes with croup is such a distinctive sound, you only need to hear it once and you have a 99% accurate diagnosis.

We turned around and went back to let mum know what we now thought was going on and to reassure her that croup in its early stages is ok but needs to be watched carefully. Trying to put all the pieces together is one of the things I really enjoy about this job.

officially useless

2006-05-22T22:04:00.000+10:00

I've just had a few days off and changed lines on my roster so I earned a couple of extra days away from the ambleeance. I have to say it was rather nice. Back to business today though and it sure was business as usual. We went to Chest pain, leg pain, head pain, vomiting, epistaxis, lacerated (by accident) and last but not least; need a sick certificate for work. Yep, we got called to a guy who has had a pain in his back for 3 years which he has seen a number of doctors about. He said he didn't get to the clinic before it closed and he needs a certificate to say he is unfit for work tomorrow, so he rings '000' and asks for an ambulance.

I tried to explain that we don't provide that particular service and that we'd be happy to run him up to hospital or even arrange for a doctor to come and see him at home. Not good enough apparently - he got all cranky and told us we were useless. Several more offers were made to help him before we wandered back out to the truck to go and be 'useless' elsewhere.

Bedtime Story #2

2006-05-12T22:56:00.000+10:00

Prompted by a story over on John Robertson's blog about breaking in to people's houses, I remembered a funny job from last year.

My partner and I got dispatched to do a welfare check on an old lady that hadn't turned up to collect her prescription medicine from a pharmacy for a couple of days. The pharmacist had to contacted the local doctor and found out she'd missed an appointment there too, so after trying to phone her, he contacted the Ambulance service. Nice to see there are still some caring souls out there.

I've done a fair few of these kind of jobs and they can be a little unpleasant - you often have to force a window or a door and go in, sometimes only to find you are too late by a matter of days.

We arrived and went through the process of knocking loudly on the door. All the blinds were drawn and there was no answer. We couldn't get around the back to try the back door because of a big steel fence. I tried to open a sash window and saw it had a small nail holding it closed from the inside. With a bit of huffing and puffing I was able to bend the nail and force the window up. We let our dispatcher know we had gained access and were going in for a look. I stuck my head in the window, parted the lace curtains and called out "hello?"...... silence.

I told my partner he’d better follow me in through the window – we’re a team right? He called me a big chicken and suggested he’d wait out front with all the bags for me to go in and open the front door. I couldn’t come up with any kind of argument that his was a bad idea so in I climbed. I kept calling out hello.. anybody home? Nothing but silence. I really hoped she didn’t own a big hungry dog. The fact that I was getting no answer left me thinking this was probably not going to end well. Whenever you are in somebody’s house like this without being invited – it is a very strange feeling.

I went out of the lounge and into the hall to open the front door. I grabbed the lock and tried to turn it. Nothing happened, it was locked from inside with a key. Damn. I called out to my partner and told him my predicament. He helpfully began laughing while I searched the hall table for a key. I’m searching among the dust and jars of potpourri, when I hear a voice behind me. What are you doing in here!! I whirl around and there is a very, very old lady, in a dressing gown with crazy looking white hair and a walking stick raised ready to brain me. Ahhhh! I think I said a word I would not normally utter in front of an old lady and quickly told her I was from the Ambulance and we were just there to check up on her. She was very deaf and hadn’t heard me calling out. I persuaded her I was not a robber and she put down the stick. Once she finally found the key and let my partner in – who by this stage was wiping away tears from laughing so hard – we found out what had been happening.

The old woman had been feeling ‘poorly’ for the past few days and decided she would go get her tablets when she was good and ready. I told her that people had been trying to call her on the phone and she said “that thing is always ringing... I never answer it anymore”. We checked her over thoroughly and after finding nothing obviously wrong, we contacted some relatives who promised to come over to spend some time looking after her until she was feeling better. I hope they did.

The basic structure

2006-05-12T18:41:00.000+10:00

I had a question in another post from Medic who asked what the structure of the ambulance response was here in Melbourne. Basically the system here is probably pretty similar to many others. We have a multi level system that has non-emergency or routine transport cars that might take patients to regular dialysis appointments for example. We also have your normal ambulance (usually a Mercedes Sprinter) which has two paramedics on board. This can be two fully qualified paramedics, one fully qualified paramedic and a student paramedic or two 2nd or 3rd year students. We also have MICA (mobile intensive care) ambulances which have two MICA paramedics on board. These guys have a similar vehicle but carry more drugs and can intubate in the field. There are also MICA single responders and Clinical support officers who often drive around in Subaru Foresters that are very nice to drive. Recently the bike squad was introduced too. I think I wrote about them a while ago.

Oh and I shouldn't forget to mention the boys and girls in the sky - we have fixed wing planes and helicopters too. And..we get assistance from fire brigade first responders and several community first responder teams. Apologies to anyone I left out.

The more serious sounding jobs will get a dual response with a MICA ambulance and a standard ambulance being sent. If it gets crazy busy then there may not be enough cars around to send two, and you are then on your own. We have phone and radio support from a medical clinician if we happen to need it - but you can't call them up and say "um.. what do I do now?" - you need to ring them with a plan of action and a justification for wanting to go outside normal guidelines and protocols.

We have this thing called "the grid" which is the program that is used to dispatch us on Signal 1, 2 or 3 responses depending on the answers given to the call takers. Many jobs are reviewed by a senior clinician after they have been dispatched and upgraded or downgraded accordingly. This method seems to do a fair job of weeding out the jobs that have got an 'overly enthusiastic' response given out by "the grid". We have had the recent introduction of a 'referral service' where a team of specially trained paramedics actually ring many callers back and spend time talking to them to see if another service (such as a locum) might be more appropriate. This works well to eliminate many non emergency calls. And of course occasionally jobs will bounce back through after more info reveals a potentially serious problem.

Yes our dispatch system has major flaws like every other one does, but overall I think it works... most of the time.

Dread

2006-05-05T09:40:00.000+10:00

A friend of mine recently asked me what were the worst jobs for me personally. I told her that it was anything involving really sick kids or grieving parents. I still struggle to actually talk about some of these jobs but I told her I'd write something about one of them here.

Driving along, coffee in hand chatting happily to my partner. Bamm. The radio announces that job I had most been dreading. A paediatric arrest. A 2 year old child, put down to sleep and found pulseless and non breathing a short time later. We discussed on the way to the job who was going to do what, and as I had managed the airway at my last (adult) cardiac arrest it was C for circulation for me this time. My partner and I were both secretly praying MICA or another crew would get there first. They didn’t.

We arrived at the same time as an MFB (Fire brigade first responder) crew who were 10 steps behind us on the way in – mum was at the door looking strangely calm as we walked up and were led to a kid’s bedroom. There was dad doing CPR on a tiny little body on the floor. Oh Crap this is a real one. Pucker factor of about 10/10. I felt physically sick. A microsecond pause as we both took in the scene before us and then it began. My partner quickly had airway under control, suction, then in with one of those tiny plastic OP airways you hoped you would never need to use, baby bag-valve-mask and some O₂ flowing in. No pulse could be felt or heard, damn. … one of the fireys was asked to begin CPR. Sit rep to the other cars that were coming… “confirm full arrest”.

I was desperately calculating the joules in my head in case we had to defibrillate her as I cut the Little Mermaid pyjamas off and put the paediatric defibrillation pads on the tiny pale body. Mum and dad are just outside the room and that horrible noise I can hear is a mother in the worst kind of pain I can imagine. I dare not look at her as I’m not sure I’ll be able to hold it together. The monitor shows a sluggish EMD bradycardia at about 15 bpm. This kid looks just like child of a friend …don’t think about that…Concentrate. More CPR, some attempts to get a history of what had happened, a pause …. asystole on the monitor. CPR again… Return of the bradycardia at about 20 bpm.

MICA arrived. Thank god. Tears of relief welled up in my eyes and I had to blink them away and focus on what we were doing. Handover was a blur. Next thing I was prepping a bag of fluid, drawing up some adrenaline and pleased not to be making the hard decisions anymore. Intubation was tricky but the guys did amazingly well with the tiny airway. I notice the MICA guys hands are shaking too. Another ambulance crew appeared and began talking the parents through what was happening. I sent someone out to get more oxygen from the car, then swapped out with the firey and began doing CPR as MICA tried deperately to get IV access.

Drugs, CPR, pause, more CPR, check the monitor… 30 then.. 40 bpm….

Come on -I’m willing the monitor to show more beats. CPR again, I look at my watch… we’ve been at this more than 30 minutes already. More CPR…then suddenly the rate on the monitor begins climbing…A pulse at last....We all work together and get ready to go, I slip my hands under her little back and scoop her up in unison with the other guys. So many hands holding so many tubes, wires and fluid. We all shuffle for the front door. Onto the bed and the heart rate is now 130. Still no sign of any breathing and we quickly load, breathing for her as we go.

We drive the MICA guys, the girl and her almost catatonic parents in to the hospital. Sitting next to her mother in the truck I can’t find any words to say, I feel useless. Come on…say something. I can’t even comprehend what she must be going through. I just try to explain what is happening - I don't know if she is hearing me. Into the trauma room, we give handover and suddenly my part in all this is over. I hear someone in the hallway say they don’t think she’ll make it. I know they are probably right. I head back out to the car to write my case notes, there is a huge lump in my throat and I feel like dropping my bundle – not now, that can wait til I get home.

Over there...we got us a waver

2006-05-03T09:02:00.000+10:00

All right I don't quite get it - you or someone you know has called an ambulance - thats good. I would too if I needed one. While waiting for the ambulance to arrive you decide to go out front and wait for it to come. Again - I can understand that, the waiting must be terrible sometimes and we all have our different way of coping.

Most people stand out on the street and when they see the flashing lights come down the road, they'll step out and wave - this can be magic for an ambulance crew who suddenly don't have to be counting houses, squinting for non-existant house numbers and trying to work out where Unit 2A of block 4, 42-45 East-something-court is while driving at a rate of knots. You look up and there is someone doing 'the wave'. This can be a slow one arm "Look, I'm a tree in the wind" impersonation or it can be the double armed "If I do this fast enough, I'll actually take off" method - both will get our attention and I'm usually very grateful.

There is another method which I'm stuggling to get my head around and that is the ESP method. When an emergency services vehicle goes past most people have a look, a few don't but most will stop and stare for a second or two at least - go on, I know you've done it. I still do it! But this other group of 'wavers' will stand out the front of the house and just stare as you go past, obviously sending you powerful ESP messages that you have arrived at the right place....and have in-fact driven past..... and that you should turn around and come back. No wave, no smile, no yell, no raised eyebrow, no nod, nothing. We do a 17 point turn in the tiny street with cars on both sides and finally arrive - where we're often asked; didn't you see me? I always try to answer this question with my mind, but I'm not sure I'm getting through. I'll have to keep working on it.

Pain in the neck

2006-04-30T22:31:00.000+10:00

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 (...how 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... :)

Oh Boy

2006-04-27T13:49:00.000+10:00

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.

Bedtime Story #1

2006-04-22T21:06:00.000+10:00

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.

Easter

2006-04-17T21:56:00.000+10:00

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.

At least try to play nice

2006-04-14T08:20:00.000+10:00

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.

3 foot high granny

2006-04-10T21:52:00.000+10:00

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.

DRABC

2006-04-06T20:10:00.000+10:00

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 was....you-could-say 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?

Days off

2006-04-04T17:46:00.000+10:00

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.

New batteries

2006-03-25T12:12:00.000+11:00

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

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

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

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

Nursing homes

2006-03-23T17:38:00.000+11:00

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

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

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

I'll rant more about this later.

The 6.30 am call

2006-03-21T12:57:00.000+11:00

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

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

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

This morning was not one of those rare occasions.

Getting spat at

2006-03-18T22:14:00.000+11:00

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

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

Commonwealth games

2006-03-17T13:32:00.000+11:00

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

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

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

First night... 6 hours to go

2006-03-16T10:53:00.000+11:00

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

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

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

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

Snake breaks cyclist's fall

2006-03-15T02:28:00.000+11:00

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

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

Snake breaks cyclist's fall

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

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

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

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

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

Here goes

2006-03-08T02:17:00.000+11:00

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

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