Dummies Guide to....being a Paramedic (pt 1)

1) Learn to remain calm when after studying for years people still refer to you as an 'ambulance driver'. Next time you cut your leg off I'll just stay in the front and drive shall I? Huh? Punk! Huh?

2) Prepare yourself psychologically to be verbally abused, spat at, assaulted, and not be able to react how you normally would were you not in uniform.

3) Realise that you are on your own. Management will very rarely support you should things go wrong. Their good name is far more valuable than you. You're just an ambulance driver remember?

4) CYA. It pains me deeply to say it, but if in any doubt as to the seriousness of a patients condition, cover your arse and take them to the fucking hospital. See point 3 above and 5 below and remember, nobody thanks you for doing the patient and the hospital a favour by offering advice to someone with a cold instead of taking them to hospital. 

5) Complete your paperwork as if it's going to go to coroner's court. 

6) Some people will assume that you know everything there is to know about their obscure medical condition. Handle the news that your patients has Proteus Syndrome in two ways. Either nod sympathetically and take them to hospital without further discussion of the syndrome to avoid being exposed as a fraud, or politely explain that you know absolutely nothing of their syndrome. Not only that, but you have never even heard of it, not vaguely. However, you should explain that if they cut their leg off you're their man. 

7) Never panic. If you can't help but panic, then never let people detect even the slightest hint of panic. It is important that you look calm-as-fuck at all times. You need to look like not a day goes past when you don't get sent to a bus that's flipped over onto it's roof, slid over a cliff and landed in a river...then caught fire...then been attacked by a huge pack of rabid dingos. Don't let anyone see that you are thinking 'what the fuck am I going to do here!?'. Stroll over to the scene with your hands in your pockets, carefully put on your high-visibility jacket, adjust your sunglasses, and hope to fuck that backup arrives sooner rather than later (hold on this is St John, we will have to request backup as they will only have sent one ambulance to 'investigate'). 

8) If you are ever unsure how to handle a situation, do not panic (see above). People may have called you because they thought they didn't know how to get Jim out from behind the awkward bit of piping at the steel factory, but they probably do. Don't worry, they will figure it out and let you know then you can steal the idea. Sometimes remaining silent and thoughtful can be a handy. If that technique doesn't appear to be working try the "hmmmm what do you think?" or "hmmmm you know what's painful jim, you let us know how we should get you out?". Always works when you're stuck for a solution to those sticky ones.. 

9) When you arrive at hospital and the triage nurse walks past you like you are Patrick Swayze from Ghost and attempts to take a history directly from the patient who they have yet to realise has advanced dementia, do not get upset. They are not showing a complete contempt for you and your profession, the triage nurse is merely attempting to cut out the middle man and go directly to the root of the problem. Makes sense.

Triage Nurse: "What's brought you in today then love?"

Lady with Dementia: "Brought me where? Who are you?"

Triage Nurse: "Do you have any pain?"

Lady with Dementia: "Pain? No? I don't think so"

Triage Nurse: "Do you know what day it is today lovely?"

Lady with Dementia : "No, is it Sunday?"

Triage Nurse: "Do you know who the Prime Minister is?"

Lady with Dementia: "Who?"

Triage Nurse: "Do you have any allergies?"

It doesn't matter that you've obtained a thorough and detailed history of the problem from the patient's family and the staff at the nursing home (as is your job), the triage nurse will be able to extract a better history from the lady. Calmly let her persevere with this until she gives up and comes back to speak to you, then calmly correct all her misconceptions one at a time as she tries to type them into the computer. 

10) If you injure yourself operating a piece of ambulance equipment, quickly read the operations manual on how to correctly operate the piece of equipment before you complete the incident report.

11) If you attend someone who is seriously ill at a doctors surgery, do not expect any useful assistance from the doctor. Don't get me wrong, GP's are great, but it's not really their thing this emergency stuff. Expecting a GP to know how to handle someone who collapses through the door without first referring to a textbook, is like expecting a neurosurgeon to run a GP surgery, or an obstetrician to perform a heart bypass. It's just not their thing, they've learnt it, but they've not had to do it in years. Some GP's are great at this emergency stuff, but quite often you might need to politely suggest the correct treatment for the patient.

Ambo vs Rambo

My blog is generally light hearted, but I can't be more serious in my disgust in reading that the government has totally backtracked on the pre-election promise to extend mandatory sentencing for assaults on paramedics. Typical Liberals. 

Read about it here, here, here, and here.

I mean seriously, if you are the sort of person who would assault someone who is simply trying to help you or help someone else, then quite frankly, you should receive a mandatory stint in jail. I'm over being lenient on violent thugs.

Some of my posts may seem quite hard-nosed, but it's mainly tongue in cheek stuff. I'm not nearly as much of an arsehole as I portray myself. When I walk into your house, I always walk in smiling, I'm always friendly, non-judgemental, open minded, ready to help. I do not make any assumptions, I do not presume to know who you are or what you are like. I do not patronise you. I talk to you in exactly the same way as I would want to be talked to, even if you have called us with a swollen little finger. I try my best to be understanding and patient.

I do not expect to be assaulted for that, and yet I have been.

I find it absurd that we are expected to go the same jobs as the police (often we are dispatched simultaneously e.g. a stabbing, naturally both police and ambulance are required) and yet we are not offered the same protection. In fact, we have absolutely no more rights to use force than the average man in the street. Not that I want to use any rights to use force you understand. I'd just rather not be assaulted thanks.

There is a list of flagged Perth addresses, about 125 of them, which we cannot go to without police backup because someone who lives there likes to assault ambulance officers. This is a great system, but if 130kg Jim Knuckles of 25 Letsbe Avenue has gone out for the night, or gone around to his friends house which isn't flagged, then we walk straight in smiling, totally unaware of what might await us.

Do I really need to describe to you what it's like working in Northbridge on a Saturday night? When nearly all of our clientele is blind drunk and spoiling for a fight, argumentative and uncooperative? When John-o is so drunk he thinks his friend is dying and yells at the paramedic and calls him a fucking c*nt as he's trying to wake up your inebriated mate whose drink 'must have been spiked' and 'why aren't you fucking doing something?'

It can be kinda intimidating...and dangerous. 

I'm disgusted that the AG has decided not to extend the law to cover paramedics (and nurses), especially after they used the tough law and order stance in their election campaign. I'd like to see us get the same protection afforded to police...I'd also like to see what sort of sentence someone would get if they assaulted a magistrate, or the attorney general himself. I'm sure that in those cases there would be no need for a mandatory minimum sentence. 

 

  

 

How to....drive an ambulance

1) Wear sunglasses. This is a must, regardless of time of day or if even if it is overcast and raining. Ambo's must wear sunglasses at all times, especially at night time. Do not attempt to drive an ambulance without sunglasses.

2) Slow down and stare evil stares through your sunglasses at anyone who does something stupid in front, to the left or right or behind you while driving your ambulance. Your stare/evil look must be maintained until they are completely out of sight.

3) Never indicate while changing lanes. Indication is for people in 'normal vehicles'. Indication may also lull someone gullible into thinking that you intend to manoeuvre left or right. This is a big no no. The ambulance must be unpredictable in its movements at all times.

4) If parking, try to double park or park illegally where possible. If you can't double park, mount the kerb with at least one wheel. If you can't mount the kerb with one wheel safely, drive the entire ambulance up onto the pavement and park outside McDonalds and go to get your lunch.

5) If you notice someone in a normal vehicle parked on or even near an emergency parking only bay or even worse 'an ambulance parking only' bay then you must manoeuvre the ambulance so as to completely bock them in until you return. Take your time returning and then follow point 2 above.

6) If driving at speed to an emergency call, ensure sirens and emergency beacons are engaged. If the person driving the light blue 1992 Hyundai Excel in front fails to notice the giant flashing christmas tree-like van 2 inches from their rear bumper, then engage the horn...continuously...until they move over to the left. Then follow point 2 above and do not disengage the horn until out of earshot. They should not be in that lane anyway doing 93km in a 100 zone. Fuckers.

7) When passing through a red light at a junction, slow to a stop and give way to the truck from the right. They are bigger than you and will make a rather painful dent in the driver door of the ambulance. You might also need to fill in reams of paperwork.

8) The brakes are fitted to ambulance vehicles only to ensure they are legally roadworthy. Use with with caution.

9) Where possible, drive down the wrong side of the road. Oncoming traffic cannot miss you as you hurtle towards them.

10) Wave pleasantly and smile at passing police vehicles. Studiously ignore passing fire trucks.

11) Do not drive on soft sand, do not run out of fuel, do not hit the kerb so hard your tyre explodes, do not try to parallel park in a small space when there are lots of onlookers, do not leave your stretcher at Princess Margaret Hospital and drive off to the next call without it.

12) Suitably loud driving music can aid concentration while driving in emergency conditions. I shall do a post on good priority one driving music at some point...

13) If being directed to park in a specific location by someone at the scene of a call (e.g. tow truck driver) be sure to park somewhere else completely.

14) When parked up in the ambulance, close all windows to avoid having to make polite chit chat with people who like to talk to 'ambulance drivers'

15) Do not balance your coffee on the central console (the one with all the buttons that control all the lights and sirens) while proceeding on an emergency call. Doing so may cause fluid to enter the central console and cause a major malfunction...I'm guessing ;-)

Perth's Hospitals: the bad, the worse, and the ugly...

You might have guessed already, but just to clarify, I am not a huge fan of the WA health system.

Why? Because I think the system needs vast amounts of investment across the board. In my opinion (and it is only that) there appears to be no correlation between WA's recent population growth and investment in WA hospitals.

The under construction Fiona Stanley Hospital in Murdoch is unlikely to solve the problem....I suspect it might not even scratch the surface. Especially if they close down RPH as part of their plans.

I don't understand how the state has been reaping the benefits of the mining boom for years and hasn't really acted on this sooner to improve health infrastructure....ANYWAY. Enough of my armchair econo-politico-pessimism. 

If I got struck down with a terrible disease and had to go to any hospital in Perth, I would choose......reluctantly.........Fremantle Hospital. I say reluctantly because, and this is going to sound a bit harsh, I have seen many many better hospitals both interstate and overseas. 

But what if I suffered some sort of physical trauma? Would I not want to go to Western Australia's premier trauma service? The much hyped WA State Adult Trauma Centre at Royal Perth Hospital,where they have specialists in such things?? Well not initially, because you can't go there directly. I'd rather go to Fremantle Emergency Department for stabilisation, then get transferred directly to the State Adult Trauma Centre at RPH, totally bypassing their RPH ED (and Sir Charles Gairdner ED for that matter), unless of course I happened to have my accident right outside RPH or SCGH. This is because almost every trauma/resus case that I have brought to RPH has (in my opinion) been shockingly handled. 

At RPH it often appears as though no one person is in control, it's chaotic, nobody is coordinating, there is no system, people are asking questions randomly, there are throngs of interns, students and PCA's everywhere, no body seems to know their role. Frankly it can be a  bit of a shit fight. And, from what I've witnessed at least, things seem a little more calm and organised at Fremantle Hospital. 

At Fremantle there tends to be one consultant in charge who asks all the relevant questions and everyone else gets on with their respective role or job. Maybe I've just been lucky at Fremantle and unlucky when bringing some poor unfortunate in to RPH, but that's the way I see it and it's my blog. I can't stress enough that this is only my opinion and it's only what I've witnessed. You ask 10 ambos what there favourite hospital is and you'll get a different answer from each (although generally they will stick to the main hospitals). We all have different criteria, and have all heard different horror stories from friends and relatives.

Joondalup Health Campus. They really really need a bigger hospital up there. It's ridiculous that pretty much anything vaguely ill/serious gets transferred down to Sir Charles Gairdner (not a huge fan of those guys either). Also, it's a pain in the arse for ambulance crews up that way as they are constantly transferring people down to the city that JHC can't deal with. They are also on bypass nearly every day...all day, meaning that they are too busy to accept ambulances that aren't coming in with a Priority 1 call. 

At the other end of town Rockingham Hospital isn't so bad. They appear to actively try to keep people there and cope with what they have, rather than ship people straight out the door like Swan Disctricts hospital and Armadale, both of which are about as useful as a chocolate tea cup if you want my opinion. Again crews at Midland, Armadale and Gosnells are continually unable to bring people in to these hospitals as they are on bypass or spend most of the day transferring patients out to the city hospitals. Rockingham Hospital also has by far the friendliest staff ever :-)

Peel Health Campus is too ashamed to call itself a hospital and rightly so. The ED here tends to have just 2 doctors on at night time. They have no facilities if you happen to actually be ill. This might have been appropriate when Mandurah was a small fishing village, but the population down there now is huge. Peel Health Campus is rubbish. Peel Health Campus aka Fremantle bus stop. 

Kings Edwards Memorial Hospital. KEMH is Perth's womens Hospital. Has anyone out there ever seen a patient in the ED here...downstairs I mean? I did once but I think she was lost. Seems to be a very good hospital though. Always seems busy upstairs but strangely quiet downstairs.

Princess Margaret Hospital. Great hospital with great staff. These guys are really really switched on. If only the other hospitals in Perth could take a leaf out of the PMH book. Handovers happen like they should. Priority one calls are handled smoothly, calmly, methodically, and they even apply correct spinal precautions.

A hospital is only as good as the staff who run it, and despite what I've said above, the vast majority of staff at all Perth's hospitals are great. The doctors and nurses do a really great job given their limited resources. They are caring and friendly even when they are dealing with the abusive drunk with a head injury who walked out against advice 30 minutes ago and promptly collapsed again. It is not the fault of the doctors and nurses at Joondalup or Armadale that the hospital might not have orthopedics, paediatrics, obstetrics or cardiac services. They are obliged to refer you out to the best available care. And they can't help it if they don't have access to  machines to test your troponin levels when you suffer chest pains during the night (Peel you fuckers!!).

101 things I enjoy about my job - part 4

46. I like it when someone else crashes/rolls/dents/scratches/knocks-wing-mirror-off/get's-bogged-down-in-sand-or-mud/otherwise-breaks the ambulance. I like it because I get to laugh at them for at least the rest of the shift, fully aware they would be equally laughing at me had I done the same thing. There is only a few things more embarrassing than getting stuck in a field on a job.

47. I like the superb windscreen washers on the Mercedes Sprinter ambulances. They are ace.

48. I like it when you are working with someone who shares equal enthusiasm for using the seat to transport patients who are fitter and healthier than both of the ambos who have been sent to get them. The stretcher is for ill people only. I regularly do not need to use the stretcher all shift.

49. Other than being an astronaut, a lottery winner, or a secret agent super spy, I can't think of any job I'd rather do. I guess that means I like my job.

50. I like to finish my shift on time...Have I already said that one? I hate getting shift extensions it fucks me right off.

51. I like it when we are called to someone who is under 80. Don't get me wrong I love dealing with nanna, but it's nice to be able to write 'none' in the medications and past medical history section of our paperwork every now and again. Saves on ink.

52. I like it when nursing home nurses use common sense and say 'Hmmm, lets call a doctor for their opinion' or the school nurse says 'Hmmm, little Johnny has scratched his knee, lets call little Johnny's parents and see what they think' BEFORE calling the ambulance.

53. At 7:45a at the end of my nightshift my favourite words are "*******21 you can stand down your call has been cancelled". I could kiss the comms operator.

54. I like bananas. Ummm ok that one is a bit weak. But I like to eat bananas at work because they come in their own environmentally friendly packaging and you can take them out and about with you and eat them no matter how busy you are at work.

55. I like my job soooo much when I get put on the day shift only ambulance and therefore don't have to work night shifts.

56. I like the fact that no matter how bad things get with the economy and 'the global crisis', it's extremely unlikely that I will be laid off or downsized. People need ambulances regardless of the impending recession. Thank fuck that they do in that respect. 

57. I can't think of a number 57....

58. I like it when the ambulance I'm working in today is outrageously clean because the person/s working on it last night were obsessive compulsive, and they scrubbed every square inch of the vehicle (you know who you are). I too like working in a clean ambulance but I like it even better when I don't have to do any cleaning.

59. I like going to Fremantle hospital. They are nice there. I will do a post on hospitals soon I think.

60. I like the air con in the ambulances, it's bloody powerful in the back and makes the job sooooooooooo much more pleasant. WTF did people do before air-con??

Happy New Year!

Ok ok so it's nearly the end of January and probably too late to be wishing Happy New Year's and stuff but Happy New Year anyway.

Oh and happy Australia day..... 

The reason for lack of posts? Um well, I'm just a bit busy at the moment...sorry about that, I'll try harder from now on.

:-)

Lucky

Recently I attended a job where a 5 year old boy had ridden his bicycle straight out into the road and was subsequently struck by a Toyota Landcruiser travelling 75kph (the driver stated his speed and said he had no time to break at all). As we travelled at warp speed to the location, drivers of cars coming from the opposite direction indicated that we should continue travelling in the direction we were travelling in (thanks!) and as we approached the scene in our ambulance I could see people looking very worried and waving frantically in our direction (both are never a good sign). 

The bike went under the car and was mangled. The child was very drowsy and limp, covered in cuts and grazes but everything looked symetrical and there was no obvious damage to his head. Witnesses said he'd been knocked unconscious for several minutes.

Needless to say that following a quick assessment and spinal immobilisation, there was some heavy footed action to the nearest hospital. 

The child ended end being discharged the following day with just minor cuts and bruises!

I am amazed, relieved, and very glad.

THAT is lucky!