She died later that night in hospital.

I spoke to paramedics who had heard the gruesome details first-hand from those on scene. Of how they felt that this was the worst scene a paramedic could attend. And of some paramedic’s relief that it hadn’t been them on scene.

I read in the local paper, the Knox Leader (June 8, 2010 – words by – Adrian Bernecich), about a hero grappling with the horror of the day. Dean Filmer showed all that is good about humanity by trying to help despite the carnage and danger. He’s also going to seek counselling after all that he’d witnessed.

I just hope the paramedic’s who attended this patient seek counselling themselves. No training or life experience could prepare a paramedic for what happened that day. Those that transported the woman to hospital would have had her cries and pleas in their ears for the long journey to one of the city trauma centres. They would have fought to keep her comfortable despite her skin peeling away at the slightest touch.

These people, the paramedics, will grapple with this horror for a long time to come and the community will probably never understand this battle.

To papers, like the Knox Leader, don’t forget that paramedics are people too. Nasty things take their toll.

I think they deserved a foot-note after this job.

While this is an obvious loss to the MICA community, it’s a great thing for the road crews in Melbourne.

With his experience and approachable demeanour, new students and experienced “roadies” will stand to benefit from his knowledge.

I know this from personal experience.

Good luck and best wishes.

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.

From the snouts in the trough excess as seen in the recent Pacific Brands white collar pay rises, while the blue collars were left jobless. To looters stealing from those who’ve lost everything. Yes they’re a pack of scumbags.

Then the other night I received a dose of reality. The real side of humanity.

We were called to transport a small child, about 5 years old and his mum to the major children’s hospital in town. He’d had a couple of seizures and needed to get a thorough once over from the neuro specialists.

The boy had cerebral palsy and had experienced seizures before. This time, however, the seizures were more severe and generalised unlike the absence seizures that he’d had before.

They’d been in the emergency department for the last four hours and the boy was in a sedated but restless sleep. Mum looked exhausted but sat watching over her son even though it was 2 am.

She said to me later that she feared that if she closed her eyes he’d be gone. He wasn’t her only son but at the moment he was everything in the world to her.

This is what life is about. The love for one another. The caring. The sharing.

Life has nothing to do with paychecks and Porches. TVs and thievery.

It was all I could do to make her smile.

I’ve never had to attend to a burns patient before, but I’ve heard stories.

I’ve been to hangings. To stabbings. To beatings. But nothing compares to the fury of nature at her angriest.

I run through in my head what I would do if I was called out to help a bushfire survivor.

The dangers. Are they responding? Breathing? Talking…screaming. F*ck.

Just take their pain and suffering away, for Gods sake. Find a vein, shaking hands. The heat.

Scoop and go. Fast. They need fluids. Where are their burns, goddammit. Airway? Backup?

Thank god for the CFA. Thank god for the volunteers. Thank god for the locals. Thank god for the ambos that attended to the survivors.

Sleep well if you can. You deserve your rest.

Stick a needle in here, wack a bandage on there. Chat to the nannas and the druggies. All in a days work.

Most of the “lights and sirens” driving is still only for the mundane jobs. A bit of reflux. My angina is playing up. In a nutshell, most of these patients have been sitting at home with the pain for a good few hours. The nans and grandads who get the chest pain generally wait until morning to call because “they didn’t want to inconvenience anyone”.

But then you do get the job. The 50 year old who clutches their chest and collapses. The little bub who blows up in a rash and struggles to breath because their little brother gave them a peanut. These are the jobs where the lights go on and the sirens get turned up and the speed is needed.

That’s when Bob in his falcadore has the subwoofer turned up and the ambulance is in his audio blindspot. The ambulance cruises up behind Bob, who has propped in the right lane and hasn’t checked his rear view mirror since he got his license.

Here’s a tip for all you folks out there:

• Check your rear view mirror every now and then.
• Turn down the subbies a tad.
• If you see an ambulance coming, try and merge to the left.
• Don’t merge like a psycho and slam your brakes on. If you cause an accident we will have to stop for you.
• Don’t get mad with the people around you.
• Don’t endanger yourselves.
• Use common sense.

If you do these things you are likely to get good karma and a wave with a blue glove from us.

Good luck out there.

Osteoporosis has taken its toll and those brittle bones are ripe for the brakin’.

Fractured NOFs (neck of femurs or the longest bone in the body) are really common and that’s what turned up today. We also had the classic dehydrated nanna in a barely rousable state. “We just thought she was havin’ a kip”.

That’s when you want some good veins to go vampire on. You just need to get that cannula into the patient to rehydrate them or take their pain away. But you don’t often get them. The older folks get, the more calcified the veins are and they become elusive. The structure of the skin on the arms has broken down causing the skin to just act like a loose fabric over the arm while underneath the veins dance around like worms when you try and pin them down.

So that’s what ruined my partners day. He was hot, sweaty and in the heat he’d worn his overalls. The barely audible cursing under his breath as he “blew” 3 cannulations in a row (not like him at all) would have been funny if it wasn’t for the poor oldies in pain and in delusional states.

You have days like these and you just have to get back on the horse. Patients need pain relief and fluid.

Come Winter he’ll be wishing for some of the Summer sun.

Well, today I met a remarkable old duck. 93 years young and living alone. Her son was down for the holiday season and he was heading home tomorrow. She padded out the back door without her walking stick to fetch something from the garage and managed to plunge head first down a set of stairs leading from the back porch.

She landed with her arms outstretched and kissed the pavement with her forehead. Her son found her trying to untangle herself with her feet still on the top step and her head resting on the concrete path three steps below.

She’d given herself a golf ball size haematoma on the hairline dead centre on the forehead and her left wrist was at an awkward angle, an obvious fracture. She had skin tears on her elbows and several of her fingers were bloodied. When we arrived she’d righted herself and was sitting on the stairs. Shaken but only mildly stirred.

“Me arm hurts a bit and I feel a bit shaky”.

“No wonder”, I said, “Someone from my generation would be screaming and crying”.

I gave her the once over but she was remarkably unscathed for such a violent trip.

Cervical spine – check. Palpate spine – check. Head, teeth, shoulders, hips, legs and arms – check. It goes to show that good genes can take you a long way. She was even a smoker.

A super-nanna indeed.

A puff on the penthrane, an air splint and she was happy. I suppose that’s one way to have your son hang around a little longer.

Our first patient had a lot of history in his very short life. Six months old, born premature at 34 weeks and born to parents that had lost their last two children before birth. Sam* was special.

A few weeks earlier Sam had been brought into hospital by his mum and a maternal health nurse. He had been struggling with his breathing all day. As they walked through the doors of the accident and emergency department Sam went limp and stopped breathing. The A&E staff ushered him through to the rescuscitation bay and brought him back. They stabilised him and transferred him to the specialist childrens hospital in the city where he spent the next six days recovering from pneumonia.

Today Sam had been vomiting up phlegm and struggling with his breathing again. His mum called the maternal health nurse who came over to check on the little one. His skin was mottled and he was unsettled. The nurse called the A&E department and asked of them what she should do. Considering his history they said to call an ambulance.

We were sent lights and sirens with an intensive care ambulance backing us up. We drove to their street which turned out to be a big bizarre loop. We finally arrived and carried the works into the job. We found Sam lying on his play mat. He looked to have mottled skin but was bubbly and active. We called off the backup crew and got some history and observations. We got mum to pack some clothes for the little one and popped them both into the ambulance for the short trip to the hospital. Sam was later admitted for a possible recurrence of his chest infection. Poor little fella. Some lives start of tougher than others. I thought to myself that this may steel him for the future. Making him more resilient. I hope so.

Later that day we were dispatched to a 1 year old boy who was continuously fitting. This time we were backing the intensive care ambulance. Maybe it was an error in dispatch but we were sent lights and sirens as a backup crew. Maybe there was more to this job than was on our computer terminal. All that aside this was a job with a paediatric patient at risk so my partner pushed the ambulance a little harder than we normally would. This job was a long way away, a good 25 minute drive at normal speeds.

Halfway to the job we approached a round-about and in a freak of timing merged just behind the ambulance we were backing. As a procession we headed off to the job. We arrived in just over 15minutes. Not bad for a drive of that distance.

The MICA crew asked us to grab our monitor and oxygen supply. We were greeted by an anxious father and hysterical grandmother. Lying limp on the couch was Jordan, our 1 year old patient.

The other crew quickly assessed Jordan while I organised the oxygen. He started to rouse almost immediately. As I placed the oxygen mask over his face Jordan looked up and grabbed the mask. He popped the corner straight into his mouth and started chewing on it. I felt his forehead and he was warm. My partner measured his temperature and found him to be febrile. The MICA crew went on to explain to Jordans mum that he probably had a febrile convulsion. Common and probably benign. I went over to cheer up Grandma.

We ran mum, dad and Jordan up to the local hospital and the MICA crew left to save the day elswhere.

It’s always nice to be able to relax mum and dad after a bad experience like they’d just been through. It’s understandably reassuring for them to know that febrile convulsions are common. That their kids may have another but chances are that they’ll grow out of them. The parents commonly ask if their kid is going to suffer from epilepsy in the future. A slightly increased chance but highly unlikely. It’s just their immature brains inability to cope with changing temperatures (probably caused by an underlying illness like a cold).

We left the family at the hospital and met them there a few hours later. Jordan was 100% but they were just waiting for him to pass some urine befoe they could go home. Jordan wasn’t playing the game.

Two paediatric patients in a row. No dramas this time. I just hope there won’t be big dramas in the future. Life can be cruel but mostly, as far as kids are concerned, life can be magic. I hope Sams mum and dad find that magic in a healthy Sam. They’ve had enough of the bad stuff.

*Not their real names.

Diagnosed by her obstetrician with an elevated relaxin level, Clair’s body was softening up early to aid in the delivery of her baby. Unfortunately with 5 weeks to go her preemptive hormone burst was just too much for her. Thankfully her Dr organised a bed in the midwifery unit and all she had to do was get there. Geography and weather conspired against her.

We arrived amidst a torrential downpour. Clair’s driveway stretched almost vertically and a steady river of muddy water coursed over its slick surface. Lugging the attendants bag up the hill I was exhausted by the time I reached the top. How on earth would we get the ambulance up to the patient? God I hoped she could walk.

It became rapidly apparent, after meeting Clair that she wasn’t walking anywhere let alone down the driveway. I sent my partner to solve the major logistical problem. How do you get a heavily pregnant woman down a very steep, slick driveway without letting her move. I just cannulated her and gave her a tipple of morphine.

From inside I could hear the roar of a straining diesel and the spinning of wheels. Shortly after my partner arrived with the bright orange wheelchair and the patient managed to struggle her way from the couch to the wheelchair.

We wheeled the patient out into the rain and down a steep hill at the back of her house. As we arrived in her carport I saw that the ambulance had made its way most of the way up the slick hill but couln’t get around the last bend up to the carport. The stretcher had been placed under cover in the carport.

Again the patient made the painful move. This time from the wheelchair to the stretcher. We then headed down the steep driveway to the ambulance. My partner was at the front and the patient’s husband and I anchored the other end. Slipping and sliding we finally made it to the back of the ambulance. I grabbed the yellow handles at the rear and held on to the stretcher while the other two manoevred it into the back. Made it. All we have to do is back the ambulance back down the driveway.

God bless four wheel drivers. The patient’s husband gave us a great tip. Pull the handbrake on a little as you back down steep slopes. It worked like a charm. I’m still sweating.

*not her real name

We knocked on the door and got no reply. There was a key lock in his meter box and we had the code. We unlocked his door and began the room to room search for the patient. Sometimes you find the old timer in bed having departed this mortal coil but, as in this case, most of the time they’ve left the house and bumped the alarm button on the way out the door.

We turned off the toilet light to offset the carbon emissions it cost us to get to him and left him a note saying that we’d raided his place. We spoke to the traditional nosey parkers across the road and to the lovely neigbours next door and left.

Fifteen minutes later we were back in our area having just exited the new tollway when we received another job almost from where we’d just been. Chasing that proverbial tail indeed. This time it was for a two car collision under the new tollway. Multiple patients. Where the hell were the ambulances from that area?

We flicked on the beacons and headed back onto the tollway, exiting about 100 metres from the accident. Windscreen assessment showed a nasty t-bone. B-pillar. All patients out of the car. Sweet.

That’s when we met Clair*. Clair, her mum and another sibling had been in the car that had been t-boned. All had minor injuries but for the sake of keeping them together we popped them all in to the one ambulance.

Clair had a nice shiner and some hip pain but just refused to complain. She asked first about how her mum was and then how her sister was. She sat in a seat by herself and chatted to my partner for the whole journey. She told him about her friends and how she was in the school play the previous night. And she just refused to complain.

I later found out that she had been fighting a tumour for some time. It was in her brain and most of it had been removed after multiple surgeries. She told me that she’d had 9 MRIs and was due to have another next week. She said that the first time she was terrified but now she could watch a DVD during the scan. That made it better. And her mum stayed in the room as well.

Then came the story of the laptop. Clair had asked her mum to grab a laptop that had been in the car. The screen now had a crack in it and the screen hinge broken. Her mum then told me that the Make a Wish foundation had given it to her because that’s what she’d always wanted.

I met a really cool kid today. She was totally selfless, totally caring, and totally funny. Let’s just hope that she meets a electronics or computer store that’s cool enough to look after her and repair the computer for her. She so deserves it.

It was an honour to meet you Clair. People like you make being a paramedic a privilege.

*Not the patients real name.

We attended to a patient in her early forties. She had an AVM diagnosed some time ago and had experienced several small bleeds resulting in arm numbness to tingling in the roof of her mouth. These events all self resolved without intervention. She was also undergoing radiotherapy a part of an ongoing treatment regime.

This morning she had her breakfast and then went to the toilet. Her partner heard a yell and then incomprehensible sounds. He opened the toilet door and found her to have minimal movement down the right side of her body. She couldn’t get off the toilet and had trouble balancing on the seat. He called for the ambulance and helped support her until the crew arrived.

Once on scene we had to carry the patient out of the toilet and onto the stretcher. In the back of the truck the patient started vomiting and her conscious state began to decline.

From toilet to truck to hospital the decline was remarkably rapid. Her conscious state went from a GCS 14 to GCS 8 in a matter of 20 minutes.

She was sent away for a CT and as they returned the attending nurse just mouthed the words to me “it’s full of blood”.

From loving partner to tragic victim. So rapidly. So unexpectedly. As a paramedic it is all you can do to get them to hospital as fast as you can. It still leaves you feeling that more could have been done.

Drop us a comment if you’ve experienced an AVM. What did you do for the patient? What was the outcome?

Suffering from anxiety and depression, Frank (not his real name), has had 5 shots at this, so to speak. 5 attempts at departing this mortal coil. Fail, fail, etcetera. Poor bugger. The system is obviously failing him and this time he’s nearly succeeded in relieving himself of the pain that he has been fighting.

This time he’s swapped the mental for the physical pain. Choosing Voltaren as part of the cocktail, he’s started to damage the lining of his stomach. Pain ensues and Frank shouts for help. His wife calls us and we’re greeted by Frank, post vomit, sitting on the ground holding his substantial gut.

He’s also taken his wife’s blood pressure meds and some beta blockers. Good times – bradycardic, hypotensive and in severe pain. We call for another crew to help us get him out of the place and in the meantime pop a line in and give him a splash of fluid. Gotta keep those kidneys going.

Even supine, Frank’s BP is just over 50/P with a heart rate hovering in the mid 40′s. Good times.

We call for MICA but we’ll beat them to hospital anyway. Scoop and run as they say.

Moral of the story. Sometimes the pain you want to escape is better than the pain you get trying to escape from it. Or something like that.

The question they get asked by the call taker is “how long can the patient medically wait for the arrival or the ambulance” and here lies the rub. Some Doctors take the proverbial p*ss.

What’s got me so irate stems from a job a couple of days ago. Big guy, did some extracurricular work for a charity and damages himself. Sciatica time. We pop him up to the local private hospital. Job done.

Next day we get a call back to the same address. The patient has released himself the night before and now, at peak hour time he can’t get back up off the bed.

His Dr had seen him earlier in the day and said to wait it out to see if the back improves. Nup. So what does the Dr do. He calls for the ambulance and says that the patient must be seen in the next 20 minutes. 20 minutes!

This bloke has been lying there all day. Now all of a sudden the Dr thinks it’s a medical emergency? Because the Dr has said it’s a medical emergency (20 minute time frame) an emergency ambulance has to be dispatched.

Let me put it in perspective, the following jobs would be regarded as a “Code 2″ just like our sciatica man:

• 98 year old grandma has fallen and broken her hip.
• A 12 year old who has dislocated their knee during a football match.
• A person who has burns to their entire arm.

So overall the Dr screws the system. For all I know there was a cardiac arrest just around the corner that we were unable to attend due to us having already arrived to see this fella. Don’t get me wrong, he was in pain, he needed to go to hospital, but what’s so wrong with waiting a little longer and going with a non-emergency ambulance.

Show some commonsense people. Ambulance is a privilege (even if you have to pay for it) and not a right.

The first job of the night began as a car rollover at a major intersection and ended up being a remarkable piece of luck.

Husband and wife were heading over to their son’s home for tea when the husband feels himself passing out. As he blacks out his foot hits the accelerator. The car launches from the lights and the wife grabs the steering wheel from the passenger seat.

She manages to dodge and weave her way across the intersection. The car heads down a small embankment, onto the wrong side of the road, up the gutter and down the footpath. She remembers looking for something hard to hit but not too hard. She picks out a large signpost and her car strikes it hard. The car is stopped.

For her troubles she breaks her right arm, a small price to pay for being able to hang on to the steering wheel. Her husband has some discomfort from the seat belt.

A lucky escape indeed.