Christmas Spirit

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

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

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

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

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

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

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

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

"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

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

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

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

Stay tuned...

Cheers,
Rob