Merry Christmas

'Twas the night before Christmas, when all through my flat,
Not a creature was stirring and I was good with that,
The phone by my bed rang out in despair,
It read 'STJOHN' and I knew what news would be there…

Other members were nestled all snug in their beds,
While visions of disaster ran through my head,
I picked up the phone, and gosh I was right,
"I can't make the duty – just realised tonight!"
Upset that I was up so late in this slum,
I got out of bed to see who else could come,
Through my phone book I went in a flash,
Hoping to pull a favor from the IOU stash.

No matter which number the answer was 'No',
I began to wander to whom else I could go,
When, what to my wandering eyes should appear,
But a miniature Sprinter and eight prepared volunteers,
Complete with a driver, full uniform donned,
I knew in a moment it must be St John.

More rapid than eagles his coursers they came,
And he sel-called and shouted out each unit's name,
"Now 501! Now 502! 503 through 950!
Grab all your gear and please don't be thrifty!
We've posts to hold! Go out and walk tall!
Now dash away! Dash away! Dash away all!"
As dry leaves that before the wild hurricane fly,
They'd overcome any obstacle, with spirits held high,
So up to the main post the coursers they flew,
With a sprinter of gear, and our old St John too.

But I heard him exclaim, ere he drove out of sight,
"Merry Christmas to all members, and to Ops a good-night!"

Wishing you all the happiest, SAFEST holiday season... I'm heading away for the break so you'll likely next hear from me on Monday the 31st of December!

And now for something completely different...

Most of my posts are made on my laptop at work (still don't have internet at home - I've known I wouldn't be there for long so just never got around to getting it).

The thing is, that laptop boasts an impressive 17" LCD screen with no added extras...

I'm currently posting from my friends house. With a monitor that challenges all other beauties in the world.

Completely unrelated to the rest of the blog, but.. damn.

Who am I to judge?

Today one of my friends asked me about some of the work I do with St John, to which I gave the usual spiel about first aid. Then they asked me for some 'War stories', which, as I do in this blog I was only happy to share. This got me thinking about two things; firstly how EMS/Paramedics/EmergMed love to tell their stories, secondly about a comment my friend made.

One of the events I covered recently gave us some drug OD's, one of which was particularly worth telling and I'll be sure to throw it in here eventually. After telling how the patient treated us, my friend commented that it was perhaps best had we just left them alone - a form of Darwinian thinking that, truth be told I've heard before. My reply was simple; "I treat them as they come, be it a cut finger, a heart attack, their first OD or their tenth OD.", which my friend didn't seem to understand... After all, surely treating OD's all the time would wear you down - and that is what got me thinking.

I think in this job you have to understand something very important - no matter how much you educate and advertise, people are still going to get drunk, smoke and OD on pretty much anything. And for most of those cases you'll hear the same mantra- "I never thought it would happen to me."

We live in a society that speaks of 'added safety features', 'extended life' and those wonderful 'special enzymes to make your skin visibly younger'. Don't even get me started on those 'therapeutic biospheres'. Most people don't realise just how frail we are, how mortal our flesh truly is. Often it is later in life, when the body has felt the toll of youthful acts that people stop to think about what they have done - and often they try to warn the next generation of (alas) invincibles who naturally don't listen.

My job isn't about reprimanding them for their actions, it's about keeping them alive long enough so that they can reprimand themselves. Will I get sick of that? Hopefully not too soon.

That's not where I left it...

So today's post will be themed around things not being where they're supposed to be. Namely, body parts.

Recently I came across such a case and it occurred to me that I was not the person I once was. I discovered this when two people walking past the scene stopped and stared at disbelief before swearing with such voracity that even truckers would blush. It hit me then that witnessing dislocations, breaks and bleeding had no effect on me anymore - they were now clinical problems that had to be treated and solved.

The first such incident was a lateral dislocation of the patella (or knee cap to us) - luckily for the patient it had clicked back into place on its own, unfortunately it looked like he had a bit of damage to the tendons. That'll be a fair bit of physiotherapy.

Next came a double break - that's right, the radius and ulna bones of the left upper limb had been snapped clean in two leaving the arm to fling around like a rat on a stick. Manipulation, perhaps surgery and of course physiotherapy.

A dislocated and fractured ankle from a happy fence jumper comes next, the bones pulling on the skin until it was white... Luckily the foot still had blood supply, so just manipulation, surgery and physiotherapy.

Another ?fractured ankle, but a bit of an odd one. There was no swelling, but there was also no sensation at all. Couldn't bear weight or push/pull against my hand. I'm guessing x-rays, maybe ct scans, a few scratches on the head and something from there. And physiotherapy.

A MVC leaves a woman with a whopping bump on the noggin (and a pretty spider web on the windscreen). A fall onto hard ground leaves a shoulder dislocated but leaves the arm with blood supply (physio).

I sometimes wander if it's a good thing I'm becoming more and more detached from this - will I reach a point where nothing phases me? I'm not so sure if that would be a good thing, but at the same time I wouldn't want every case to stay with me. In some professions more than others, you shouldn't take work home with you. How will I work out? Time will tell, but currently I'm happy with my reactions. I still have the internal monologue of "that's so cool!" followed by "Can I get you some pain relief?", but I don't know how that would apply to some of the more serious accidents.

Moral of the story? Make sure you leave things where they belong - otherwise a man in a little blue jumpsuit might be grinning at how cool it looks. And you'd need physiotherapy.

Take long, deep breaths Part 2

A week since the original post and I'm only now doing the 'second half' to what I see as a two part saga.

The first half of the story centered around the attitude of different Paramedics in their approach to patient/carer/first aider interaction. This has a profound effect on the way the situation is seen by those involved, and while I will always aim to hit that second 'calm and friendly' version, there are times when even I as a first aider can see why and how the first 'sit down, shut up' attitude is taken.

From my experience (as limited as it is) in St John Ambulance, some people who are trained to do first aid take the 'Ambulance' part far too seriously. They think they're Paramedics just because their uniform reads Ambulance. This is far from good - they can get cocky, make mistakes or just generally be an all round jerk. It's for this reason above many others that I believe a portion of Paramedics dislike SJA, and I have to admit I don't blame them. I've seen people who have professed vast experience and intellect practically soil themselves when confronted with a real scenario or, as some patients/friends are prone to do, generally get in the way or use inappropriate terminology or treatments.

Fortunately for me, I only catch this once in a while - but I can imagine Paramedics would get it all the time. After a while (particularly if it's been a bad day) it would be easy to become frustrated with these types and find it easier to just do the job as you were trained. Sometimes a little attitude rubs off, though.

But imagine this also; you've just come from a child in RA who you've dropped into A&E knowing full well will never recover fully, even possibly not survive. Your next call is to a broken leg where a first aider is generally messing things up, using the wrong terms or possibly even doing everything right - it would be natural to be more disengaged and less sympathetic to that patient because you know they're really ok, and given a few weeks will be able to fall again when next they emerge from the pub drunk. Maybe they've just had a month of overnights, maybe they've just seen enough pointless spilled blood that week. It's about perspective.

Will this always be the case? Of course not. Some people are just jerks.

But it never hurts to think of both sides of the story.

Common sense (and why it isn't always common)

A good deal of what we do in first aid is common sense. Anybody can do it - most children, when asked what to do if they cut themselves would be able to tell you to put a band aid on it. There is one little catch, however, that has shown me time and time again why such a simple thing to treat can be changed into something a lot more complicated.

From the newest member to the most hardened veteran of first aid (sounds silly, I know), I've seen people freeze up at certain types of injuries. Some people don't like blood (again sounds silly but I've seen first aiders go pale at the sight of it), while others don't like screaming patients. I've done it too, but I'm trying more and more to stop it. Sometimes your brain needs a few moments to collect itself when confronted with a particular sight, and it's something that you need to condition yourself out of in order to become better at this. Some injuries require immediate attention, so you won't be given those moments, and it's a trend I'm noticing going through the Paramedic literature that an important part of the job is getting around that initial mental hurdle to get back to that common sense.

But this raises another point - Paramedics condition themselves to adrenalin, as the job puts the body into a stressful state for frequent, long periods of time. This is a two edged sword; it allows the Paramedic to work in stressful situations to accomplish that which may not ordinarily be accomplished, but it can also lead to chronic fatigue and a depletion of mental resources. It can burn you out. A good Paramedic will be able to find that balance, the sweet spot between exhaustion and exhilaration that leaves them in the right frame of mind for the job. I've heard it's not easy, and not everyone can do it despite their best efforts. It can hit you straight away, or slowly wear you down after years on the job.

Will I be able to find this spot? I hope so, but I guess you'll only ever find out through a trial of fire. All else fails, I like to think I'll still be able to use my common sense.

Super happy fun time update

And so I have a fair bit of news for this post! An update both of what's happening with the Ambulance Service of New South Wales (which is who I'm hoping to do the Traineeship with) as well as some happenings with St John.

Firstly, apologies but I'll have to delay the 'other side of the story' as promised in Friday's post - rest assured that's what Wednesday will cover.

Secondly, and much more excitingly, I received a call from ASNSW Friday (shortly after making that post) telling me that I was successful in the previous round of Aptitude Testing and that they would like me to come in again. Not only that, but they were keen to fast track me, so I will be sitting the next two rounds (Full interview and driving test) on the one day being January 10th. This was very good news for me - the fact that I had been contacted only 1 week since doing the tests implies that I had performed well, as they tell you to expect a call after three weeks when the ranking is completed. On top of that, a friend of mine (who happens to have just landed a job with MAS, but who had also applied at ASNSW has told me that they pretty much tell you after those two rounds if you're in or not - so I may very well be able to tell you that afternoon if I've entered the first real step into my new life. My friend has also offered to run through some of the questions to expect and other general pointers - greatly appreciated!

The other news is in regard to St John Ambulance, who recently purchased and decked out a new Mercedes Sprinter with the new design splashes. I was fortunate enough to have been allocated the vehicle (ok, so I begged) for a duty last night (Carols by Candlelight), given it was a well populated area it doubled as brilliant advertising for the organisation (photo above - who could that handsome devil be? - More photos coming as soon as they hit my inbox!). At the end of the night when they were calling out the thanks, St John got a mention and so we did the compulsory lights flashing which got a laugh from the crowd. A quiet night casualty wise (the way we like it) but still a rather enjoyable night!

With Daft Punk coming up with St John this Thursday, I'm sure I'll have plenty of stories to keep me blogging for a bit longer ;)

Take long, deep breaths...

I'm posting Saturday's post today, because I know tomorrow is going to be a nightmare of activity for me. An early post? I'm shocked too.

The idea for this post came to me after reading Baby Medic's post 'Real Strength', which I think is compulsory reading for anyone in the field. What I want to talk about today is the aura you seem to get when working in an emergency setting.

There is a long running joke in St John Ambulance about the 'Paramedic Strut'. Basically, whenever a Paramedic walks into one of our posts following a 'Code 6' (call for Ambulance), they tend to strut in with the flag billowing in the background while they calmly ask "So..." *pause for effect* "What seems to be the problem here?". Naturally, the girls (or guys, should the Paramedic be female) swoon and the patient will miraculously recover at their touch - once more the world is safe.

What this joke refers to is the sense of authority that is immediately identifiable in a Paramedic. I tend to summarise this into two categories, and this is where Baby Medic's post comes into play.

The first type of Paramedic will come into the room and ignore us (St Johnno's) completely. They will do their obs, perhaps ask a question or two to the person in command and then get irritated when said person isn't familiar with one of the terms or methodologies the Paramedic is referring to. They assert their authority through a sense of aggression and condescension. While I'm the first to admit we are only First Aid (more on this later), it is this first type of Paramedic who leaves a bad taste in your mouth long after the ambulance has left. They use every technical term to talk about the situation and the patient is often too scared or feeling too incompetent to actually ask what is wrong with them.

The second type of Paramedic walks into the room, says hello to everyone and with a calm grace takes in the situation. They take obs, also asking the Johnno's around questions and explaining any terms/methodologies in a conversational and respectful way. They talk to and reassure the patient, explaining in simple terms what the problem is and why going to hospital would be the best idea - but reminding them it's their choice. It's this calm and respectful stance that I've come to admire about certain Paramedics.

Of course a single Paramedic may have a combination of both attributes, and this may also change from day to day - the job is demanding, tiring and often frustrating. But at the same time, the attitude rubs off, so even if you're feeling frustrated it's important to keep that calm.

Before any Paramedics flood my inbox (not very likely... but still) with emails, I'll be making another post on Monday with the other side of this story from what I can gather. Then please email me if I've left anything out.

Blogging about Blogs

I've come to appreciate blogs as more than just a spleen venting pit of the internet - they're a chance to tell the world your story.

First let me say thank you for taking the time to read my vented spleen, and also to let you know some of the spleens I enjoy reading - mostly of people who've traveled down roads similar to the one I hope to travel.

Basically, they have better stories right now ;)

Baby Medic - http://babymedic.blogspot.com
Inept Pike Fishing - http://ineptpikefishing.blogspot.com
Trainee Paramedic - http://traineeparamedic.wordpress.com
Other People's Emergencies - http://urbanparamedic.blogspot.com
PurplePlus - http://kingmagic.wordpress.com
Street Watch - http://medicscribe.blogspot.com
The Paramedic's Diary - http://paramedicsdiary.blogspot.com
Policeman's Blog - http://coppersblog.blogspot.com
The Thin Blue Line - http://thethinblueline.blogspot.com

If you've enjoyed some of my stories, try theirs...
Just make sure you come back!

Dance the night away

It was a duty like any other, only it happened to be a youth dance competition... At first I thought it may have been the annual Oompa-Loompa reunion given the amount of orange skin and wigs.

After several hours of boredom a young boy (around 14) 'hopped in' complaining of an ankle injury after a stumble when leaving the stage. I had a quick look by lifting up his pant leg and then fled to the opposite side of the room calling on anything holy to protect me (of course, this didn't really happen...) as I noticed his ankle was around three times the size it should have been. After taking a few more obs I followed the nifty little RICE mnemonic for soft tissue injuries and was recommending the joys of a trip to the local hospital to get an X-ray to be on the safe side. This was not to be...

The mother of the boy refused to leave, saying the child still had one more round - the Grand Final to compete in. I looked at his ankle. It looked back at me, whimpering. I looked at the boy, who seemed determined to keep his mother happy despite the risk of further (major) damage to his already damaged ankle. As the boy was under 18, his guardian had right to deny treatment.

I hadn't removed his shoe, given it was holding in the swelling somewhat and the parent had already said they wanted him to be able to dance. If the shoe came off, the swelling would immediately spread down into the foot and any hope of getting a shoe on again (and thus his ability to compete) would be lost. I was so tempted to take that poor boys shoe off... But alas, I had not the right.

This places us in a tricky situation. I had fully informed the mother of the potential harm she was doing her son, but still she refused. After a bit more talking we came to an agreement (which I still hated) - she took her son from the First Aid room back to the event, covering his ankle with his pants (thankfully loose fitting). Nobody was allowed to know he had been there (not that we give out any details on our patients) and, if we pretended nothing was amiss she would 'allow' us stand side of stage if he collapses. How caring of her.

This is where the story gets strange (I know). The boy goes on to dance. The boy wins the championship. Nobody notices his ankle, three times the normal size, and he walks off stage as if nothing were wrong. That boy must have been in tremendous pain - and as he walked to his mother out of sight of the crowd you could see his limp and unshed tears.

He may have won this championship, but I shudder to think the damage he may have done to himself or - more to the point - the damage his mother had 'allowed' him to be exposed to. I hope he's still out there dancing (he was good), but I'm hoping more that he was allowed to heal before his next competition.

Some people just shouldn't be 'allowed' to have kids.

Regarding my mental abilities...

Ok, so as promised this post will be a run down of the Aptitude/Psychometric testing - and an explanation of the last two post titles.

To start off, I was sent to the Ambulance Service Education Center, where we packed in like sardines to sit the tests. And boy, did they last a while...

The first round was language, where we were given a paragraph from which we were expected to be able to extract certain information which we could apply to a given question. Fairly straight forward, fairly easy. There were a few questions where I was very happy for my prior medical knowledge, but overall it was based on common sense. There was one question which stuck on my mind regarding heat stroke, where they give you a bit of background then talk about a patient you arrive at who was jogging but now found on the ground covered in sweat. Asked if you think the patient had heat stroke, most people put no - the patient was sweating, which stops in heat stroke. Luckily I put maybe (more information needed), much to the chagrin of the others at lunch break, because he had been jogging, so may have been sweating from that prior to cessation of sweating due to heat stroke. One to me :)

Next came Mathematics skills, which is where I feel I excelled. I've always been pretty good at maths, given this was still at a fairly simple and I've successfully completed a university mechanical biophysics course - so hopefully I was fine.

Map reading I may have made a boo-boo on... I only realised today I may have gone the wrong way down a one way street, but only for 10m so I should be ok... We had 2 minutes to work out how to get from one side of the city to another! And Sydney is renowned for its one way streets...

Word association came next with logic/pattern recognition - the inner geek was actually enjoying this section! I've since looked up the tests on the 'net and got all of this section correct - go me! (PS: I need to get out more)

Now it was around this time that the real pain started - the previous tests told them how smart we were. The next test was the Aptitude part - a long test provided by the Dept of Forensic Psychology. This was the meat and potatoes of the test, because you could be the smartest person alive but if this test said you didn't have the right attitude, you would not progress. I have to point out a few questions that took my interest;
Select the answer that you identify with best:
a) I avoid responsibilities and work whenever possible
b) I like to criticize my bosses behind their back

ARGH! What's the right answer?! I chose b, simply because I don't think avoiding responsibility helps you - but there were many questions like this that made you stumble a little. Then they would re-ask certain questions in slightly different ways to see if you're consistent (or at least a consistent liar ;P).

True or False:
I believe I may secretly have unusual mental abilities which I cannot talk about in case people don't believe me.
Related:
I hear voices in my mind

Does anyone actually put 'True' to these? If so, I hope I never end up transporting them...

Overall the Aptitude section was the hardest. There is no real way to cheat it because they talk to you about your answers in the interview (next round), so they'll catch anything you've 'made up'. And it asks some fairly personal questions too, again which you'll have to be candid about if you're serious about going for the position... I decided to be honest about everything - even some of the things I was afraid they might not like - because I feel that they'll understand a) I'm only human and b) sometimes life throws curve balls, and they're important lessons we can learn and evolve from.

I find out in three weeks how I went (or at least when my interview is if I'm through to the next round) - you'll know as soon as I know.

Until then, 'normal' posts for a while ;)