Despite the number of “aids” that paramedics have to help them transfer patients from one place to another it sometimes comes down to moving someone quickly and damning the risks.

Or does it? Is it worth it?

Would the public eye us with contempt if we save ourselves before others?

I spoke to an ambo the other day and she said that her back was so sore that she was probably going to have to head home and take some time off. She said that they had to move a voluminous patient from beside a toilet. It was a difficult move for them because the patient had an obvious fracture to her leg. The stretching and lifting at the same time had caused her some lumbar back pain and a couple of hours later she was “feeling it”.

Injuries like these can seriously limit the lifespan of a paramedic.

What can we do?

We use the aids as best we can but sometimes we just can’t. I suppose that’s the price we pay for the privilege of doing what we do. Helping others.

What do you think? Do we have to risk ourselves sometimes? Is it a matter of further training? What other “devices” could we utilise? Should we use the “spoonful of concrete” approach to patients?

‘Tis the conundrum.

Be safe peoples.

Call us anti-money chasers but ambos tend to take on a lot of new skills and don’t take anything in return.

With the new EBA happening and paramedics likely to experience a pay cut overall, we’re still willing to tackle new skills like Intranasal Fentanyl, IV Dextrose, new burns dressings, and MDI Salbutamol. All of which benefit Joe Public but increases the expectations on the Paramedic in Victoria.

On the other hand, firemen gained allowances for things like CPR. Is it paramedics goodwill or the proactive fire union that made the difference?

Don’t get me wrong, firies rock – especially when they turn up at cardiac arrests to do compressions for us. Good on ‘em for getting the cashola.

Anyhoo – it’s all food for thought. I’m leaning towards feeling that our union has dropped the ball. We’re looking at a capped 2.5% raise while Alfred hospital physio’s, etc are looking at 5+%. good on ‘em too I say. They earned it after falling behind.

Maybe next time for us?

If there is one thing in life that I’ve learnt. People over complicate things.

Back in the day I had a hell of a time passing my university degree. I always had questions floating around in my head about everything I’d learned. To many whys and not enough acceptance. All this did was to brick up any further learning. Then I’d start falling behind.

I vowed never to go back.

Then I did.

This time I accepted what I was told. I kept up. I went home and read. I answered those questions in my head, in my own time, at my own pace. The simplicity of it all just clicked.

This is why, if I can, I break everything down to its most simple form. Even being a paramedic.

So here’s the theory:

• When you meet the patient find out first if they’re alive, dying or dead. This should be fairly obvious.
• If they’re gasping give them oxygen. If they’re not breathing, start CPR and pop the defibrillator on. If they look like they’ve had a big trauma, have someone stabilise their neck. If the blood’s pouring out, stop it. Otherwise take a breath.
• The next step is to find out what’s wrong. I reckon the best way is to ask them. See, simple is nearly always the best.
• Get a baseline. Conscious state, blood pressures and heart rates, see how well their breathing is. This’ll give you an idea as to whether they’re getting worse or if your treatment is working.
• Treat what you can treat and transport.
• Done, QED, keep it simple stupid.

This is just the standard clinical approach. Don’t over complicate it.

You’ll fix the diabetic hypos, and the heroin overdoses. But if they’re sick I say leave it to the folks that earn the big bucks. There’s only so much you can carry anyway.

Some days you just wish you hadn’t put the right shoe on the left foot when you woke up.

“The other day” was one of those days.

My partner and I received a job just around the corner. Looking at the pager I knew it was the local skate park. Some winner had taken the plunge off the edge of the bowl and hurt himself. We soon earned an upgrade to bells and whistles when the caller said his mate had fallen a couple of metres on to his head and then had a seizure.

We pull up and peroxide boy says his mate is awake and talking. “He’s sittin’ o’er on the chair ma’e”.

That’s when my day went south. Fast.

Firstly I got three stories. “He was unconscious straight away”, “Nah mate, he crawled out and sat on the chair”, “he was shakin’ for ages”, “mate, I tell ya, he was awake when he was shakin’, mate”, “hang on let me get another photo”, “this is goin’ to MySpace tonight”, “oh yeah I ‘fink he had somfin’ comin’ out ‘is ear, like water”.

We just went around in circles.

We checked his spine and grips along with his conscious state. We put a collar on him to support his neck, just in case and popped him onto the stretcher. He had no base of skull fracture signs. His pupils were a-ok. His vitals were fine and he just wanted to go home.

We just couldn’t put him into a category. He’d possibly had a seizure and possibly been unconscious at some point in time, so we spinally immobilised him. His injuries didn’t fit out time critical guidelines so I felt he’d need a hospital that could do some CT scans, just in case. My partner was undecided but did feel concerned by parts of the story, understandably.

So we threw the ball to the captain and got some external thoughts.

The clinician felt the major trauma hospital in the city was the way to go. Just in case.

Sorted.

He got a cannula (which he hated), ECG, O2, a trickle of fluid, a big time secondary survey (examination), and we made sure he was strapped down tight, just in case. I suppose that’s what it’s all about. Just in case.

For the rest of the shift I just felt, “wrong”. In some ways I felt that I’d lost control of the case. Perhaps if left to my own devices I would have gone to the wrong hospital and the patient could have deteriorated. I just don’t know.

Next time I’ll know. I think erring on the side of caution is the paramedics best option.

Somedays you look at a patient and just think to yourself, what is going on?

Most of the time it’s the humble chest pain. Is it their ticker or last night’s tikka?

You start of thinking that the pain’s a bit low, the patient ums and aahs about whether it’s their breathing causing the pain, and you just end up thinking – stuff it – treat for the worst case scenario.

I must say that I did visit a patient who had the classic chest pain after lawn mowing too much – and he just kept mowing – needless to say he got the stent that he was after. But things are always a lot murkier.

We recently received a call to a very dark path in a very dark park. The caller said that they couldn’t hang around but she’d seen a female in her 60’s unconscious on the gravelled path. Face down.

We pulled up and started wandering down the path. The 4 bystanders just stood arms crossed, chewing on fingertips. No one knew her and no one had turned her over to stop her pressing her nose into the dirt. That’s when we noticed the decerebrate posturing. Ooh, that’s not good.

We gathered some of the masses and, taking care of her spine, loaded her to our stretcher. We got her in out of the night and took a closer look. First glance said that she’d had a bleed in the cranium. Big haemorrhage in the brain. Stroke.

That’s when we got back to basics. The causes for altered conscious state? Number one – hypoglycaemia – low blood sugars. We felt it was a longshot, what with the decerebrate activity and all, but a drop of blood from a finger’s a quick test. And that would cross one thing off the list.

The reading was “LO” of the scale in a bad way. This looked like this ladies’ lucky day. As long as her brain wasn’t fried.

We got backup on the way, because they don’t trust us with IV sugars “yet”, and we gave her the Glucagon, popped a line in and waited for the cavalry.

Just as backup arrived she started to wake-up. A bit more magic juice from MICA and we trundled off to hospital.

She was itching to get home by the time we got to hospital.

I was going to verbal on a bit more about another job but you can only read so much before glazing over. Suffice to say the moral of the story is:

In ambulance things are never what they seem. Think outside the container.