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.

40+ degree heat (104F) is truly hard and dangerous work. It’s not just the sweating Nannas that appreciate the hard work.

Despite Ambulance Victoria (AV) running an ambulance service propped up by paramedic goodwill (overtime), AV has managed to secure a 20% pay cut on this goodwill.

It’s remarkable that paramedics were threatened by Fair Work Australia and Ambulance Victoria for even thinking about withdrawing from voluntary overtime (due to fears for public safety) – yet on the other hand Ambulance Victoria allegedly dropped over 20 ambulances from service the other night (allegedly commonplace too). With no repercussions.

Viva La Pay Cuts – except for the boss’ $30,000 pay rise.

Nice.

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?

Frightening to say the least!

Is this because of union/eba issues, disillusioned ambos, people “chucking sickies”, or what?

Any way you paint it – don’t get sick.

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.

“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.

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.

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.

Fluid in a patient that’s 20 years old and 100kg is really not too much of an issue. Their ability to fluid balance isn’t usually in question. But the nanna who has a history of needing to take her “fluid” tablets and sleeps with 3 pillows propping her up is a different ball game.

It’s all a matter of balance.

However when someone describes the following scenario I get a little concerned:

Mary is a 30 year old. She’s played a bit of tennis in the morning and has just driven to the local cafe for some lunch with friends. She felt it was a nice sunny day and she wanted to catch up with her mates. Mid-way through lunch she feels sweaty, nauseated and is noted by her friends to have stared off into space for a good 15 seconds. She responds but is a little groggy. Her friends call for the ambulance.

Johnny/Jayney ambo wanders in. They find that Mary’s BP is low. Sitting around 75mmHg and she’s a little tachycardic at 105bpm. They don’t try and move her and get a friend to hold her shoulders as she sits on the seat.

The ambos pop some oxygen on through a Hudson mask and moniter her ECG.

They cannulate her with an 18 gauge cannula and dump some Hartmanns into her venous system. Her blood pressure starts to come back up. They grab the stretcher and zip her up to the local hospital where she’s given the once over by staff. She’s discharged a couple of hours later.

What’s wrong with this picture?

Oxygen – check. Monitor – check.

Then it all goes wrong. They cannulate. Why?

Sure the ambulance guidelines say that this person could use some fluid but the basics have just been missed.

The patient’s history says that she’s been active on a sunny day. She’s been racing around and has now sat down to a meal. She’s already a little dehydrated by the sport and then the eating has put her body into a more parasympathetic mood. Vaso-vagal anyone?

Females in general have lower blood pressures than males and dehydration plus the eating is naturally going to knock the blood pressure about.

The body knows what to do. It wants you to lie down. Simple.

What should the paramedics have done?

Lie the patient down and elevate the legs. Give her a minute and her blood pressure will pick up. Let her rehydrate in the normal way. Fluids by glass not by needle.

Mary would then have headed home with a friend and not had to tie up a public hospital bed.

Simple is often the best.

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.

The state government has taken some steps towards warning people to “look after each other”, but I really think that a few simple things will save us all and give the paramedics out there a rest.

• Drink water – like they say – 2 litres per day.
• No slip, slop, slappin – just stay out of the sun.
• If you have to go out, go to air-conditioned shopping centres.

Logical and simple.

Ambos get sent to too many old timers who’ve dehydrated themselves. Instead of risking your life in this heat and copping a huge great needle in your arm with some salty water running up it – just pop your feet up and watch the tennis.

‘Nuff said.

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.