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.

Complaining about the state of the nation and the world appears to be our national pastime. At least for now.

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.

In recent weeks I’ve had a couple of paramedics come up to me to talk about fluid. More specifically about how their partners have used fluid in patients too aggressively (in their opinion).

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.