Morning Mist Part 2

The mist is back this morning... Calm, beautiful, like the last breath of air the earth ever takes.

He lies in the grass, motionless. He's been still for quite some time, and the mist has claimed him as her own. Two dogs - his dogs - bark at the gate a meter away, one excited by this strange new game his master has come up with, the other angry that these two men were probing their master, connecting strange things to him and shaking their heads slowly.

They were young dogs, with many years left in them. Their master, also young, unfortunately did not.

The two men walk back to their van, nodding to the other men, police, that the job was done. Their breath mists in the cool morning, tiny clouds fall and vanish almost before you could acknowledge them...

Two dogs bark, the men drive away, leaving the master in the care of the mist.

Car vs Pole

Pole always wins.

It was towards the end of a day shift, it was becoming dark and we were looking forward to heading home for the night. Dispatch, as usual, had other plans for us.
"We're going to send you down to a MVC, no details at present - unknown patients unknown status".

The Mobile Data Terminal (MDT) flashed with the job and we ran lights and sirens to it. I threw on my fluorescent safety jacket and gloved up - I hate jobs marked 'unknown status'... Even though the descriptions are usually wrong, they put you in the mindset of what to expect. Unknown means you might get there to find a parade of elephants storming through... or maybe not.

We arrived shortly after, a crowd had gathered around a car wedged between a brick wall and a pole - the opposite side of the pole to the road... Now that takes effort. The car was empty, and it took a moment for people to respond when I asked 'Was anyone hurt? Who was in the vehicle?', a young male sheepishly walks forward.

On examination he seemed fine, and although we made numerous offers to take him to hospital he refused - our examinations only go so far, there may have been internal trauma we cannot possibly detect without scanning equipment, found only in hospitals. Still, he was happy enough to make his own way home via his girlfriend - but what really got to me with this job was his attitude.

"Yeah... this'll be the second time I've done this..." he laughs. "No scratches, I'm fine."

A grin on his face, as if he's almost proud of what he's accomplished.

"Lucky there were no pedestrians nearby - this would have killed them. School finished only a little while ago..." My eyes betray my disdain, I care about his welfare but it's obvious it's not about him as a person. People like this who have no regard for others or the impact of their actions make my blood boil. It will take another accident and a life lost before anything will sink into his head.

The smile is wiped off his face, he mumbles something about going to his girlfriend and we head off. It was our last job, and I went home wandering how the story might have unfolded if any one of a million variables were even slightly different and was glad that they weren't.

I doubt he spent the night the same way.

Kids are indestructable... almost

So there we were, two ambo's driving around minding their own business when all of a sudden our terminal flashes.

We have a job!

Usually this would be cause for groaning and mumbling (joking, I swear) - but this call would lead us into a late meal and thus more pleasant pay packet. There's always something to celebrate in life.

We head down for a '?#' - possible fractured limb. The destination is a sporting oval that my TO knows well, and as we head down we see a game of under 12's rugby in play - this is going to be good. Coming from a different state, I never really got into rugby - but from what I've been able to gather the game essentially consists of one team trying their best to kill another team.

We knew then that if this was going to be a fracture, it was going to be done properly - and we weren't disappointed. We pull up at the windmill (otherwise known as a person frantically waving at an ambulance * see note below) and see not too far off a boy around 12 holding his arm and looking rather sorry for himself. His arm shows us why. He'd managed to break both bones of his forearm, the Radius and Ulna, the limb distal to this break flopped painfully with each movement he made.

He still had good circulation and sensation to the hand, something very important to check - because if the break has somehow damaged the vasculature or nerves it's going to be a very speedy trip to hospital for emergency surgery. I gave him some meds for the pain which almost knocked him out. The parents were a little worried about his decreased level of consciousness, but a quick chat convinced them it was for the best - what we had to do next would be something he probably wouldn't want to remember. As gently as possible we maneuvered the arm into a padded cardboard support, the poor boy still let out a semi-conscious groan of pain, and we slung it into a supported position. The meds are fairly quick to wear off, and as we drove off to the hospital we were able to have a bit of a chat and he told me about the game, which for the record ended in a tie.

I'm not sure exactly how many people have been inside a moving ambulance, but I'll give you a hint now that they're bumpy. We kept the poor boy on pain meds but still each pot hole and bump in the road left him a little sore.

We left him with the lovely doctors and nurses who promised to take good care of him, with a promise of ice cream being heard from a nurse as I walked through the exit.

He was going to be just fine...

* Note: To people who insist on waving to an ambulance while the lights and sirens are on - please don't do this unless you're the person we're going to - or at least going to take us to the person we're going to...

Nothing like a good night jog

We were called to a male pedestrian hit by a car. It's night, so we have our sidelights on as we scan the area for the accident - unsure if the driver has fled the scene or not. Two men flag us down, we assess the scene as we approach. Something about this job seemed odd from the get go, we're not taking any risks.

The men tell us they saw the incident, the car is down the road but the pedestrian - hit by the car at a relatively high speed - ran off down the opposite direction.

My TO looks at me with a look of disbelief on his face, I mirror the look to our flagging-down friends. The MDT flashes with a new notice, that the patient had ran home around the corner and called 000 from there. The look of disbelief stays with us as we head to the given address.

I'm treating officer for the night, so I grab our oxygen and first aid kit and head inside, a woman is waiting at the door and guides me to her husband. He sits in a dining table chair, a red towel pressed against his head. I swear silently to myself and start my assessment - the towel was, but half an hour earlier, white.

He was normotensive and seemed fairly stable, alert and oriented, full recollection of events and denied loss of consciousness - but he had an egg on his head that would serve a family of four. It bled fairly freely and took me a while to get under control, ample time to work out exactly what had happened. The car had hit him as he jogged across the road, and for whatever reason he had thought it was best he head home to call an ambulance... despite hearing the driver of the car call an ambulance. In these situations it's hard to determine if there perhaps is an altered level of consciousness or if the patient is always this silly.

He was, given the mechanism of injury, in fairly good shape, but we took full spinal precautions anyway much to his discomfort - collars are horrible to wear for any length of time. His head would definitely need a scan to check for any internal damage or bleeding, and we sped off into the night.

I'm trying to find out how this one turned out - the bump on the head was quite nasty and I'm curious if they stitched or glued the head wound and how the scans turned out. I'll be sure to let you know!

Lights and sirens

The terminal flashes, another call has come in. It wasn't the first for the day and we knew it wouldn't be the last. Traffic is swelling as the day wears on towards peak hour. It's a 1B. Lights and sirens. We turn into a shining beacon of hope, a wailing beast cutting its way through the populous.

"Cherries." she says simply. "I like nougat with cherries."

Breathing problems. Pt is alert and oriented, severe respiratory distress.

"I've always preferred almonds." he replies, a vague look on his face as if he were remembering a nougat long ago.

"Chocolate." I contribute, "The best nougat is always coated in chocolate."

I can see I have impressed them. A smile spreads across her face and a fond grin on his. I was the third person on crew before being placed into probation, the ride along. I quickly discovered that the intense look on a paramedics face when driving is usually unrelated to the job, and I laugh at how much fun I'm having in this new job.

We race towards the patient, hoping to do whatever we can to make sure they survive another day.

After all, we don't know nougat do they like.

Laughing baby is healthy baby

It was early in the morning, the kind of early that leaves you wandering who would even be awake to call for an ambulance. Unfortunately people were awake, and had called for an ambulance. Inconsiderant, I know...

The call was for a 1 month old in respiratory distress - lights were on in an instant and I ran through the checklist of scenarios in my head, equipment that would be brought and, thanks to my Training Officer (TO) who would do what for each scenario with what drugs and treatments we could use.

We got to the address quickly and got into the house, anxious father in tow. In front of us sat the 1 month old, a smile from ear to ear in a warm blanket in Mum's lap.

We ask what had happened, the anxious father tells us how his son had been sleeping, suddenly awoke bright red and had coughed up a fair amount of clear sputum and had gone back to sleep. My TO grins - with 5 kids of his own he knows full well what has happened and later tells me this story is not unusual for first time parents.

It is easy to forget that babies aren't just little people - their brains are still wiring up and many organs aren't fully developed at birth. A good example of this is that babies lose their swallow reflex when asleep - and as was the case here, as saliva is continually produced the baby wakes after having a minor choke on the unswallowed saliva. After getting that out of the way, they usually just go back to sleep - if the parents hadn't been there they would never have even known it had happened. It was almost certainly not the first time this had happened, and definitely wouldn't be the last.

The relieved and sleepy trio came with us to hospital for a 'just in case' checkup, which although we didn't think it was needed were more than happy to provide.

Taken directly from my record; "Pt stable and sleepy en route", laughing to myself I thought the Pt and myself had a lot in common.

Morning mist

It's the early hours of morning, my partner and I are driving back to station after a long and grueling night shift. A thick morning mist has spread across the land and as we drive down the highway I can see the vast fields around us covered with it, like a curtain trying to hide the events of the night. Maybe it was me hiding from the world, maybe I'm just overtired.

He lay in the back of the ambulance, motionless. His frail frame covered in sores and bruises from spending so long in bed. His old age was shown in every feature - from his thin wispy white hair to his lithe and withered frame. I didn't even take a blood pressure, his arms so thin I feared even the inflation of the cuff might snap the brittle bones. Baseline observations had been taken as we left the hospital, I write these down on our records.

His skin had thinned so much I can almost see the cancers that have invaded almost every major organ in his body save his lungs. Asthma and a chronic chest infection was now claiming those.

He stared vacantly out of the window, knowing his end was near. Knowing I knew his end was near. He mumbled something, it takes me a moment to realise he's asking for another blanket, and even though he came from one of the good hospitals with clean linen, I discard his spare used blanket and get him a fresh one from our linen. His eyes tell me of how much he has lost - time with loved ones, freedom to move around as he pleases, freedom from pain. Worse is knowing the final blow - his right to die at his home as he wishes. His wife rides up the front, visibly restraining herself from crying as we near the Palliative Care ward of his new and last home.

A dark cloud stayed over the ambulance the entire journey, and although I heard small talk coming from the front between my partner and our patient's wife, I know nothing that is said is really being listened to. The back remains quiet as our patient returns to sleep, possibly the only comfort he has left.

We're driving back to station and I look out into the mist. I watch it slowly cover the land and hiding everything underneath. I prepare myself mentally for the next job, a routine I've become accustomed to regardless of the patient previous. A last memory flicks into my mind before the mist covers it too - the last words I said to my patient after moving him into his ward bed;

"Well mate, get some rest, it's still very early - and Happy Birthday."
He sqeezes my hand and smiles, if only for a moment.

One month to the day

As the title suggests, it is one month to the day since my last post... The reasons why are numerous and varied, but ultimately discussing them would be a waste of your valuable time. The essential thing to remember is this; I'm back, I'm a Level 1 Paramedic and I finally have time to continue this journal as such.

I've also managed to get StretcherMarks working again after a major server crash, so if you're in the industry why not take a peek and join in the fun? I even managed to upgrade the backend from Joomla 1.03 to 1.5, the new core code is much more flexible and has thus allowed me to merge a phpBB into the same login system, making chatting in the forum significantly easier.

So sit back and relax in the knowledge that some rather interesting stories are coming your way, back to the update schedule of Monday, Wednesday and Saturday.

Tumbleweed begone!

Yes, it's been quiet here lately - not because anything is wrong, just because I've started my on roads and I'm flat out (and completely buggered). Good news is I have a lot of new stories to tell, I'll be sure to type them all up when I get some time off over the weekend and schedule them as usual.

'Till then, have a sneak peak at what happens when you get three ambo's stuck in one of the few comfortable waiting rooms while a Pt gets ready to be transported... ;)

I love this job...

Cool little things...

One of the cool things about my course right now is that I'm backwards diagnosing some of my old patients...

Boy with big floppy ankle? Oh - he had a Potts fracture! Lovely old lady with Angina? Unresponsive to her sublingual spray and duration of pain makes that a possible AMI (and makes me very happy I called the ambulance!). Carpal spasm? Hypoventilation due to drug use!

You get the point...

Looking back on most of the patients I don't think I'd have done anything differently back then... which is a good thing I think... Doing it now, I'd do a lot more - but only because now I have that extra training, knowledge and resources I'd be more confident in my treatments. There were times when I wished I could administer advanced pain relief, confidently read an ECG or even just move the patient in some circumstances - none of which I was legally allowed to do with St John.

I guess my point today is this; from here on in I'll get to do all of the cool little things that make big differences in patient comfort and outcome...


Until of course I go up the next training scale and look back again!

Bigger than a band-aid

One thing I remember happening in St John a few times was that you would get 'senior' members who flat out refused to do anything but the 'big' cases. I'm not sure if I've blogged on this before, so if I have - bugger - if not, great. Because it's something that keeps popping up in my Paramedics training at the moment...

The thing that got me with the people in St John (and I don't doubt you'd find these in every emergency medical/first aid service) who were of the 'big stuff only' mindset was that they were missing the two biggest points to do with pre-hospital care; looking after people's health and looking after people. I was extremely pleased to see that one of the steps in Protocol 1 (the very first Protocol!) in our protocol book is 'REASSURANCE'.

The people who only seek the 'big' cases (BC's for short from here on!) miss out on the real work of any good ambo - looking after people, regardless of if anything is actually wrong or not. The big test is usually if someone comes into a first aid post looking for a band-aid. Our BC's scoff at the thought of applying a mere band-aid, such is their skill and prowess that they must hold themselves in reserve in anticipation of that big fish. In my opinion, it is the humble, friendly member who puts the band-aid on the persons (usually smelly) feet, has a chat with them and walks them out the door when they're ready that is really doing the good work. Because they're fulfilling both neccessary steps of being a good medic.

Unfortunately I've seen a BC in action at an OD, the patient was transfered to an ambulance at said BC walked off grinning at what a good job they'd done. Right past the girlfriend crying because she didn't know if she was going to see her boyfriend alive again (which in that case she definitely would, although perhaps a second trip to hospital would follow his initial release thanks to said girlfriend's 'welcome home'). I remember the look on her face - desperate and vulnerable, terrified and lost. Fortunately a nurse got to her and directed her to another vehicle headed to the hospital, they had a chat before she went off and I don't doubt for a second it did her the world of good. The patients on our run sheets and cas forms aren't the only people we treat. A smile, a slight touch of reassurance, a kind word are often worth more than the most expensive equipment you can pack into an ambulance.

I know that, as often happens, I will grow tired of doing the little things. I won't want to put the band-aid on the foot, I won't want to do the simple little procedures. I like to think I'd do it anyway with a smile, or hand it to a probie (be nice to probies! please?) who needs these experiences - but not because I feel I'm above it.

They drill into us here that we are public servants in all senses - we will politely oblige the lovely old lady who has fallen over in her thirty roomed mansion. We will also politely oblige the homeless man who has passed out in a pool of filth.

I hope that no matter how much training or experience I get, I will never - for an instant - think I am bigger than a band-aid.

Heavy lifting

This is a retrospective message out to the ~150kg man who briefly passed out on the basement level of an event. Myself and a guard had to carry him up a narrow flight of stairs in a collapsible wheelchair (I still don't know how we got him to fit on there...), of course I had a little trip and hurt myself for a brief time.

Still thinking of you, and looking forward to repeating the experience with your brothers and sisters out there in the world...

- Peace out.

Toilet humour

One funny thing about working major events is the number of calls that lead you - one way or another - into the toilets.

Now, aside from the obvious joke that the toilet is where you'll find disgusting shit - a call into the porcelain shrines usually provides a few chuckles or at the very least a grin or two. That is of course providing you don't actually have to touch anything, and your sense of smell is tolerable of such places. But it seems that the drunk in particular have a unique affection for these places, and I'm never quite sure if it's the constant need to void the bladder after a few too many beers or the fact that somehow - somehow - they know there's nothing we love more than trying to lift a 130kg man from a pool of his own vomit, urine and... other surprises in a confined and crowded space.

Nine times out of ten you're there for a drunk who has either decided the small benches inside some toilet blocks would provide a better resting site than anywhere else outside, but there's always that other one time that keeps you on your toes and reminds you that this can be an unpleasant place to work.

Treating the drunks is usually easy - make sure there isn't some underlying medical problem, help them outside and watch them go on their way (and by that we mean anywhere but here).
Most of the time they just want to be left alone to go sleep off their little adventure, but sometimes they insist of vomiting on you, despite all efforts to convince them that it isn't in their - or your - best interest.

But every once in a while someone comes along to make your life hard. Maybe they've passed out inside a cubicle (a personal favorite, as there's usually no easy way to get into these urine-soaked domaciles without a high chance of getting yourself 'contaminated' - thankfully this has only happened to me once so far), passing out on the floor or (and I've only heard of this happening once) passing out while standing up at the urinals. Fun. I know this is something I'm only going to see more of now in the service, and it's something I'm dreading even before it's really begun.

For all the perks of this job, sometimes you have to put up with a little toilet humour.

Where's the marshmellows?

Driving along one sunny afternoon in the trusty St John vehicle, my partner and I noticed a strange sight before us; a burning vehicle.

Sensing that something was off with this sight, we decided to pull over and check what was going on. Luckily the good folk from MFB were already on scene and doing their thing - but interesting was the fact that we were the only medical team there... The vehicle was very much aflame and there seemed to be some kind of high-temperature fire happening underneath the vehicle, because even after half an hour of absolutely soaking the underside of the vehicle in water and chemicals the vehicle was still merrily burning away.

And did I mention we were the only medical crew there?

We had done the compulsory 'Hi, what's happening?' with MFB, checked out the 'occupants' of the vehicle who were fine and had no smoke inhalation and spent the rest of the time sitting on the side of the road hoping it didn't all go pear shaped.

Fortunately for everyone involved, it didn't, and before long we were able to go again on our merry way. MAS had been held up at a major event for the day and so in the end we, who just happening to be driving past, were all that was available. MFB were very grateful for us stopping I think, and although we all knew fairly quickly we weren't needed, there was always that 'just in case' that made us stick around.

After all, cars and fuel tanks have known to possess a volatile relationship...


All in all a lazy job but with some pretty neat visuals to go along with it - I was happy nobody was hurt, sad that two nice people who had only recently come to Australia had lost their car and wishing that I had brought some marshmellows.

All in a days work ;)

Future in doubt!

Well today we had a test. It went.

More important than the assessment of my intellectual capacity however is the patient confidentiality and privacy session we had after it... At the end of the session I asked about the policy on blogging - something I had raised several times with other trainers only to be told I should bring it up in this session. The overall picture was they didn't want it.

Tom Reynolds, a Paramedic who also blogs on the side, provided a lot of inspiration to me and was a large factor in my decision to start this blog. A fair while ago he posted on this exact issue, and this is something I'm currently using (along with a few other bits and pieces of information) to appeal this decision.

Essentially at the moment I can blog about my thoughts and views on certain topics providing they are exactly that, and I distance myself and my opinions from any service of an ambulatory nature. I am not to discuss anything to do with any patient work I may or may not have/will come across until this issue is decided.

Rest assured even if this decision is made going against my views, this blog will continue. I will still have my little vent in here about the general life, but no 'work related' issues will be brought up. I will continue to discuss medical issues and may even be able to slip in an 'example of a hypothetical situation' from time to time providing I have distanced my thoughts and views from the service.

Frustrated? Me too - but I'd rather be working towards a solution to this than hitting my head against a brick wall, so expect the next post Saturday as usual!

What you won't find in a book

As a friend of mine pointed out in a comment to a recent post, there are a lot of things that don't get taught in any book. The feeling of looking at someone and knowing how little chance they have. The desperation in your heart and hands as family members look on to you pumping oxygen into their loved ones lungs because they stopped breathing on their own. The look of children on their grandmothers face as her 'chest pain' gets worse, isn't responding to the 'nice mans' medication and the ambulance is yet to arrive.

There are a lot of things that can't be taught through any book, partly because they're experiences you simply wouldn't want to share with others, partly because they can't be described in words. These are the quiet moments where you look into your soul and see yourself as a mortal being, rife with fissures and cracks - ready to break at any moment.

These are the moments when people look at you - the medical professional - and expect you to have some miraculous therapy or treatment to help the person they love keep living, and as much as I would love it we usually don't have the answer they would like.

As my friend rightly puts it, "this is definitely going to be one of the hardest things to do..."

Unfortunately it's something we'll have to get used to doing, after all, we all have to die of something - and with modern medicine people are living longer but dying in hospitals as we try to squeeze every last drop of life from their body.

The hospital giveth, the hospital taketh away.

Earth Hour 2008

I am pleased to say that I participated but a few hours ago in Earth Hour 2008!

Basically it just meant turning off lights and what not - anything that used electricity. While I know the impact was only for an hour, if you multiply this out by the number of people all across the world who participated, I'm sure you'll start to see just what this is really about.

Saving coal and other sources of energy for a bit is not the point - it's about raising awareness. What started in one city (an Aussie one at that!) has spread around the world to increase awareness of the state of the environment and our impact on what is left.

If anyone hasn't done so already, check out http://www.earthhour.org/ for more details, and make sure you take part in 2009!

Thoughts so far

Well, almost at the end of another week of training and I have a few thoughts about it so far...

It's intense - the sheer volume of information, whilst not overly complicated material, is overwhelming. Despite this - I love it. Even though I'm yet to go on road, the nature of the training we are receiving and the skills we're expanding on every day makes me wake up each morning (still sleepy and irritable, but also) excited and ready for another day.

But it isn't all perks. When we first got here we started a line of questioning for some of the senior paramedics, a way of getting to know the things about the job that the public don't hear. Best job, worst job, goriest job and saddest job - the story that's stayed with me the longest comes from one mans saddest story...

He was called to a possibly deceased and when he arrived, sure enough there was a deceased man laying there. He had been dead for possibly several hours, and no attempt at bringing him back was going to be necessary. He was an elderly man, the person who made the call was his wife who had found him 'sleeping' in their bed. After telling her the bad news, she sat there silent for a moment.
"But... what do I do now?" was all she asked. They had been married for over 60 years - every day together, every moment shared. She had spent vastly more of her life with this man than without, and just like that - he was gone.

These are the situations we don't have protocols for, that we can't train for no matter how hard we try. These are the hardest parts of the job and the real test of strength.

I like to think that one day I can stand in front of a class of new recruits and tell them my stories - the best, the worst, the goriest and the saddest. I just hope mine isn't so sad - but I know it will be, and that it's a part of what the role entails. I want to be good at this, and then I want to be better - I'm not doubting myself, but I hope I have the strength.

That's something you won't know until you're standing in front of that frail old lady, alone for the first time in decades and scared, tears welling in her eyes as you desperately try to stop the ones welling in yours.

Feeling faint

There's something that happens on a regular basis at major music events that would be quite amusing if it wasn't so damn annoying for us - people (predominantly young girls) 'fainting'.

Now if someone has genuinely fainted, I'm all for heading over and helping them out - it's just that this is usually not the case. We have a term for this; 'playing possum', as possums are known to 'play dead' when confronted by a big scary animal to detract attention. These people do the same but to achieve the opposite - the 'patient' doesn't really need medical attention (of the non-psychiatric kind perhaps) but pretends to so that the big scary animal (me, naturally, and their friends) give them the attention they so crave. Some of you might remember I've blogged on this before.

The case that makes me bring this up again occured at (surprise) a concert where we got a call from security to attend a faint at the rear of the arena. My partner and I were the closest responding crew being at the front of the stage (naturally ;P) with the fastest route being through the crowd to the back of the arena. While it didn't take us long to get through, it's never a nice thing to have to shoulder yourself and your partner, each laden with big heavy gear through a crowd surging in the opposite direction to an aging man singing about teenage angst. Kids these days...

We arrive at our destination to find a security guard with a grin on their face - the patient 'didn't want to wait, so she decided to walk to a designated first aid post to faint'.


But as I said at the start, sometimes these faints are serious in nature. My sympathies go out to MAS who recently had an influx of such patients - although I can't vouch for all of their validity - a fair proportion have been reported to me by a worker as legitimate faints. With the warmer weather here I'm sure not looking forward to next summer!

One final thing - this article was released a few days back almost implicating the police of killing a man with capsicum spray... sneaky reporters twisting the scenario! Murderous cops sells papers, the heartfelt efforts of overworked, under appreciated and often abused (verbally/ physically/ mentally) police doesn't.

We have liftoff

Well, here I am. It's now the second day of commencing my new role as a Trainee Paramedic and I'm loving it so far. The people are fantastic - the training staff are friendly and eager to teach you (although frequently reminding you that there is a LOT of content to cover in very little time), the higher level trainees and other staff keep reminding you to hold on while sharing their stories and the people in my class are awesome. They come from all walks of life, from a gym trainer to a carpenter to a physiotherapist - even a fellow biochemist!

I have to admit, so far I am thanking my lucky stars for my medical background, which has made the content so far fairly simple to learn. A lot of others without the background are starting to worry, but we're going to run some study groups lead by those who have the background (I'll be helping with chemistry, metabolism, anatomy and physiology) so that we'll all feed off each others strengths.

This class comradery was fairly apparent from word go (although most of us are still trying to figure out who everyone is!), and I'm truly inspired by the general atmosphere of the 'family' of the ambulance service.

I'm getting my uniform fitted tomorrow which should be fun - but till then back to study!

T-Minus (again!)

Quick shout out that tomorrow I leave for Sydney.

Hopefully internet on Sunday, means actual post.

Till then,

Of Mice and Men

I decided to get into healthcare because I felt like I wanted to make a difference. I wanted to reach out to those in need and make them better, happier or just plain alive.

It was a very short time in my life where I held those convictions, because very quickly I realised how little difference you can make, how a lot of the time reaching out to those in need can earn you a punch, that gentle words and proper treatment doesn't always help the pain, and some people you just can't keep alive, no matter how hard you try.

Despite this, I still found the work rewarding - the small victories keep you going. I loved the hands on nature of the work, chatting with different people and hearing their stories. I loved the random 'How the hell did you manage that?' casualties and the ones that make you think on your feet - sometimes literally, as you wheel a patient across to the acute casualty post.

Some patients stay with you long after you've handed them over, be it by their past, their present and why you're seeing them now or because you know what the future holds for them. A while ago I had a patient that stayed with me for all three reasons.

He was in his early thirties and had been walking home from a night out with friends. He had severe skeletal deformities of congenital origins, the details of which I'll go into in another post. I only mention this here so you'll appreciate further the next sentence. He was beaten - bloodied and bruised - by a mob of bypassers for no reason other than he looked different and was unable to defend himself. They had thrown him down and kicked him repeatedly until he had stopped crying - his arms, legs, chest and even his head.

A civilian happened to drive by approximately ten minutes after the attack and noticed him lying in the bushes, almost invisible in the night and had pulled over to see if he was ok, had noticed me driving by in a marked vehicle and flagged me down.

He was taken to the ED, examined and was found to have 'minor injuries', but was in quite a deal of pain. Combined with his history was going to spend a night or two in ward for observation.

This job stayed with me for quite some time after the attack, the sheer stupidity of it and the damage ignorance had caused. I have no doubts that alcohol was a contributing factor in this attack, and that this is becoming a larger problem each week. Still, this wasn't the first beating I'd had to treat and I wish (oh how I wish) it would be the last - but I know the world doesn't work like that. People are always going to do stupid things for no reason, sometimes damaging the life of another. 'Tough' guys with something to prove beating up an innocent, crippled man.

Despite helping clean him up, treat his injuries, I felt powerless to do anything significant at all. But he thanked me for my help, and despite my feelings of ineffectiveness I felt maybe I had achieved something - even if it was just to reassure him that he was still alive.

Some patients stay with you longer than others, but in some way every patient's story changes you forever. You're never quite the same person after a big job, be it for good or ill, but I like to think of it as I'm always growing. Each day, each job makes me a better person, maybe not from gaining hands on experience but by hearing someone's stories, watching their plight and coming through it. Through their strength I gain my own strength, through their struggles I can overcome my own.

For that I am always thankful, and ever wanting to be better at what I do.

Getting ready for the move

Well it's now only a week before I start driving from Melbourne to Sydney - my brother has kindly volunteered to come with me for the drive to keep me company and he'll fly down later.

But the process of getting ready for the move has proved to be a lot more difficult than I had first imagined... I'm no stranger to moving around, having lived in four different houses over the past three years - but for some reason this move is different. It's as if by moving interstate a certain part of my life is being left behind, although I hope I can pick it back up again when I return, and that until then I pick up something of a life in my new job.

One thing that I wanted to do - and luckily was able to - before I moved was to travel around the city of Melbourne and take a few happy snaps to remember the place by. I'll upload them into here so you can all get an idea of what I'm talking about.

I'll miss mornings like this, coming into work with the sun rising beautifully on the horizon. After watching this I was always happy - I knew my morning coffee was only minutes away...

I'll miss the 'cafe culture' of Melbourne - I've already discovered finding a good coffee is nigh impossible after 5pm in Sydney...

I'll miss my family, including my puppy (even if he may be 12 years old...) who is staying with Mum at her place.

I'll miss my friends, those who I went to uni with, those I've worked with, those I've met and trained in St John with - I'll miss them all.

I know I'm still going to be around, coming back down every three or four weeks, but the fact that these things won't be right there in front of me while I'm in Sydney is something I'll miss. I know life is about change and progressing forward, but it never hurts to be able to look back and smile over the past.

On a side note, my recent acquisition of a Nikon D40X means I'll now be sharing some of my posts with accompanying photos. As the above attest, I'm still very amateur - but stick around and we'll see if I can't improve.

Working with Patients: Common sense, a bit of medical knowledge and a dash of art

Most of what I’ve come to find when working with a patient is that there are three factors that need to be taken into account to ensure the process goes well for everyone; common sense, medical knowledge and a certain finesse that you have a little of at first and develop with practice.

I’ve heard of a few Paramedics becoming qualified through a three year university degree, started working on the job and realized they either hated it or were no good at it. This is incredibly sad – imagine spending three years of your life, as well as accumulating a massive financial debt to find it isn’t for you. While of course you have the option of translating that knowledge to another field (as I have done with a medical research background) to ‘save’ some of the effort – I’m fortunate enough to still intend on returning to research (long) down the track when the situation improves.

The trick lies in balancing those three factors of sense, knowledge and art to the benefit of the patient and enjoying it. Bowel pain could be cancer. But it also could be related to the aspirin and beer they took earlier. Common sense differentiates the two. But combined with other symptoms, your medical knowledge may flip that back to the cancer scenario, and you recommend further checks. The art is knowing when to use what – as well as how to relate all this back to the patient.

It’s this constant juggling that appeals to me – I like to think I’m a creative person (I play two instruments, design websites and am about to dabble in photography), I like to think I’ve got medical knowledge (BBMedSc(Hons), SFA w.AdvResus inc. SAED, HAZMAT and BIOHAZ trained) but know I still have a lot to learn (especially regarding emergency medicine) and in the common sense department I feel confident – but I can always do with a little bit more! A couple of times I’ve come up with a plausible diagnosis that was previously missed or hypothesized a scenario which has later been revealed as correct – but all of this means nothing if you don’t know how to work with patients.

A patient (usually) doesn’t have your medical knowledge, and so for them this triangle is incomplete, they’re often in pain and in whole the experience is unpleasant. Working with patients is in its own right an art form, a delicate dance of trust, respect, care and assurance. To be able to assess, if possible reassure and always relate the situation back to the patient is an integral part of the work, and something I have thoroughly enjoyed so far.

As always, I want to be better at what I do, and perfecting this balance is something I see myself being devoted to for some time.

Reverse Voodoo Doll

I’m in the ward again for the clinical trial – and I’ve become somewhat of a celebrity with the nurses and doctors.
‘Number 19 - the one with the crap veins!’

Yes, we’re numbers – occasionally we’ll be referred to by our initials but I kind of like the ‘Hitman’-esque nature of the number… I’ve always known I’d make a horrible IDU – I’ve got the smallest, deepest veins… Once you’re in they bleed well, but getting a needle in is much akin to the haystack story… Luckily for me needles don’t phase me in the slightest (working in a HIV research facility gets you quickly used to them, as scientists need a lot of ‘control’ samples… guess where they come from?) and I’m more than happy for them to take a few stabs.

One of the doctors has it down to an art taking from the veins on the dorsal surface of my hand, but most people don’t like taking from there. So most take a stab at the Median cephalic or Median basilica veins, and miss. Or the Median cubital, and miss. My Radial vein is actually quite big and juicy – perfect for venipuncture – but unfortunately it rolls quite easily away from the needle and both times one of the nurses tries she’s forgotten to stabilize it and missed. Oh well, live and learn.

I can’t help if there’s a doll somewhere in the world wandering why it keeps getting these stabbing sensations…

Given my studies, I’ve come to help them find the best veins to use (much to both of our amusements), together we’ve come to find a few that work and many that don’t. I like learning the practical skills and many of the newer nurses enjoy the practice on a ‘difficult’ case who is willing to give them as many shots as they want.

Here’s hoping I get someone like me when I go on hospital placements!

A growing burden on us all

As mentioned last post, the growing rate of binge drinkers is, in my opinion, becoming an epidemic in Australia. Worse still is the younger age of onset, with 14 year olds being given addiction counseling for drinking habits. Despite previous posts implying that the vomiting, wasting our time and resources as well as the physical discomfort associated with working with the soberly challenged being the bad parts of heavy drinking – the really bad parts are things I’ve never really mentioned.

I’ve seen families being torn apart following a member binge drinking, with often fights spilling out into the street as they leave whatever venue they’re in. I can only imagine what this must be like at home. I’ve seen ‘normally quiet, fun-loving and calm’ (friends testimonies) people swear, spit and bite and those trying to help them – including their friends. The toll taken on the private lives of binge drinkers, their families and friends is phenomenal.

Add to that any medical costs for ambulances and hospital care, police fines for drunk and disorderly, public nuisance and the financial toll becomes enormous, on top of the funds required to actually purchase the alcohol. To make this final step easier, liquor suppliers are more than happy to provide you with cask or clearskin wine at a fraction of normal costs and budget spirits and beers to keep you happy. Thanks.

Add to that the cost of a liver failing on you. Kidneys can no longer keep up with the demands being placed on them. Eyesight can fail as the small vessels that supply blood slowly waste away. Internal organs die as they’re literally preserved (and not in the good way) inside the living body. If you try and stop you might go into alcoholic seizures, your body going through withdrawal of its vicious routine. This doesn’t just happen to every-day-and-night drinkers, this can happen to those who binge drink only one or two nights a week. The physiological cost is your life – in every sense of the word.

When I recently got called to a young woman who felt the need to drink an entire bottle of spirits I wasn’t laughing about it like her friends. It’s almost a given that at parties like the one I was at there’s at least one person in this state – it’s a joke that they’ll be teased for over the next few weeks, but nothing more. I usually treat in a ‘kids… *sigh*’ attitude in these situations, which truth be told I did in this case. And, as usual, I gave a brief spiel about the dangers of drinking in excess, both the kids and myself knowing full well that it fell on deaf ears but that it had to be done – as if this too was part of the ritual. I’ve done it enough times now to know it isn’t going to change anything.

I wanted to grab the girl and scream at her – she was a university student, bright and with a good future ahead – was this how she wanted to live her life? It only takes one mistake to ruin an entire life. What if her friends hadn’t been there when she fell? What if she was alone, and started choking on her vomit? What if a sexual predator had found her instead?
A parent came later and took her home, a look of mild amusement on their face behind their outside ‘anger and disappointment’ as if they were internally reminiscing on when they were that age and got drunk. The cycle continues.

God I wish it would stop.

Vomit transfer protocols

I’ve mentioned quite a few cases of dealing with drunks in my short time blogging, but I’m always amazed at the people who feel it’s perfectly normal to put themselves into a state of severe inebriation. Now I’m no saint – I’ve sported more than a few hangovers in my time and, on occasion, put myself into a state of severe inebriation – once following what I’m sure was a reaction to the high preservative levels in extremely cheap wine (I’m allergic to sulphur, of all things…). Thanks go out to Clare for looking after me! (Still sorry…)

I can say however that those events were fairly few and I know for a fact that my days of drinking more than a glass or two are well and truly over. But I’ve noticed some of my friends show a little disappointment in this decision – it’s very Australian to go out to the pub and crawl home.

Working with St John (and also a few bursts of looking after friends at parties) I’ve been abused verbally, had punches thrown at me, had a bag of vomit thrown at me, pulled people out of gardens, been vomited on directly and passively (explanation to follow!). You reach a point where looking after the drunkards makes you realize just how unappealing drinking is – and not just for yourself.

The times I was vomited on directly usually run something like this; security bring someone over who is obviously drunk. They deny being drunk, despite their breath smelling like the bathrooms of Young and Jackson’s Pub following St Patrick’s day and a stupor that would impress a Zen master. After taking their obs they suddenly announce they don’t feel so good, you turn to get an em-bag only to find they project over the bag and onto your uniform. I’m proud to say I have since become the ninja of vomit dodging. Unfortunately, practice made perfect.

The passive vomit stories are the worst though. We get called to a drunk who is passed out in a pool of their own vomit. They are covered in it. A sterna rub or shoulder pinch brings them to (usually angry) but we convince them to sit up. Now we have to walk them over to a post, and the fun begins. We can clean up the vomit off their face and hair, but clothes soak in the stuff – and as we’re sometimes forced to do the old ‘throw your arm around my shoulder’, we get to join in the soaking. Occasionally we’re lucky enough to have waterproof (and hose-clean-capable!) jackets or a scoop and stretcher – but often resources are spread just thin enough to make the shoulder the only quick method of transport. That is passive vomit transfer, and the stink stays for the rest of the duty.

Getting sick and vomiting is only a small part of the problem however – but I’ll save that for next post.

Stay safe.

Took their breath away (but gave it back again)

There are a few perks to being a member of St John that often get either overlooked or blown completely out of proportion - the one I had recently was that of the adoration of dozens of schoolgirls. I had to laugh.

The basic story - at a high school sports carnival we had two kids run into the first aid post yelling that their friend couldn't breathe. This usually translates to asthma attack, so we grabbed our gear and off we went. The girls ran ahead, but we (professionally) maintained our steady walk. We got to our patient, a young girl with (*surprise!*) asthma. She was breathing shallow with a bit of a wheeze, but was conscious, alert and stable. We administered Salbutamol - she had her own but had left it upstairs in her bag - as well as a nice steady flow of oxygen to give her that universal pick-me-up. When she was a little more recovered we walked her over to a room we had set up and put her into a stretcher for a little bit to rest it off.

I could have told her that morning that participating in two endurance events without her Salbutamol handy might not be the best idea and a minor asthma episode was to be expected. What I hadn't expected was to emerge from the room to have dozens of girls staring at me. It was very... Children of the corn.

One of them piped up with a worried look on her face "Is she going to die?" - I let out a grin.
"It's ok, she's fine - just a little asthma. She just needs to rest for a few minutes and she'll be out again."
"Thank you!" the girl cheered and ran off.

The rest of the duty went quietly and quickly - another minor asthma episode and I was free to go home from yet another job well done.

Getting ready to say goodbye

Possibly the hardest part of my life at the moment is getting ready to say goodbye to Melbourne - my family, friends and life as I know it.

I have done a fair bit of travelling in my life, having lived in several places across Australia - but somehow Melbourne was always 'home'. Well, for at least the next several years I'll have to learn to call Sydney home - and having been there a few times I don't think that should be too big a problem. Except for the heat.

I'm a winter baby - give me rain and snow, I'll be happy. Give me sun and I'll be looking for shelter faster than you can say 'Gollum!'. Having said that, the past few years have actually been warmer than Sydney during the winter, so I guess the shock won't be as big as it could have been.

The hardest part is the financial side of things. Having lived as a PhD student, I got into the routine of surviving financially - but now that I have to move to Sydney I realise I'm broke. Enter the clinical trial, which should pay for (thus solving) all of my problems. It ends on the 15th of March, I drive to Sydney the 16th and classes start the 17th - the downside being that I don't get my cheque 'till the end of the 15th. It's a Friday. This means there's a high chance I won't be able to access these funds until the Monday classes start, despite the fact I'll need the money to actually get to said classes. I'll figure something out - I always have - but it'll no doubt be a blogworthy tale!

Wish me luck ;)

Side note: Only just got onto the internet after a considerable length of offline time - it was horrible! Also, the power cable for my laptop decided to snap, denying me access to my pre-written posts. This means double the whammy when the new cable arrives as I post the articles.

When vehicles attack!

It's common knowledge that some Paramedics attract certain kinds of jobs - even before I've become a fully qualified Paramedic I know my niche.

I attract car accidents.

Since joining St John Ambulance, I have had at least 8 car accidents happen right in front of me. Normally I'm in civilian clothes, but have my trusty kit in the back of the car (something I highly recommend people get!) and have been able to help out where possible.

Usually they've been low speed collisions, for a long time the most major injury I had to treat was a bleeding scalp following a minor spidering of the windshield. Of course, I made a point of saying 'until recently' because this leads into todays story...

A car was t-boned (one car ramming head first into the side of another) in front of me, the scene instantly turning to chaos. I pulled my car onto the grass and jumped out, kit following me. Fortunately I was in my StJ overalls, so people actually listened when I yelled for an ambulance. The driver who hit head on was fine, walking from the wreckage left behind him with only a look of disbelief and slight tremble of the hands. The driver who was hit side-on was a different story, having not had the luxury of a full crumple zone to lessen the impact.

He said he had lower back pain and pins and needles down his legs, so I told him to stay sitting and try not to move while I did a quick primary survey to check for bleeding. Luckily I didn't find any (although this does not rule out internal bleeds), and quickly jumped into the passenger seat behind him to immobilise the c-spine (his neck) with my hands. Unfortunately I had switched from a marked St John vehicle only a few hours prior, and would have had the luxury of proper fitted collars - but I knew this would do until the ambulance arrived.

To everyone's luck the ambulance arrived in short time and we got a collar on and we got the driver onto a spine board to be loaded. The crew thanked me for my help and everyone went on their way.

This job left a firm thought in my mind that I was doing the right thing by applying for the ambulance service - and also gave me the confidence to believe that I could actually do this. I hated the feeling of not having the equipment I knew I needed, but at the same time enjoyed (not the right word, but you get the idea) the fact I had to think on my feet.

I also learned a quick lesson in patient management, having my friend in the front shifting from time to time (with me grumbling at him to stop each time) until eventually I just warned him he could move one more time, shift something and never be able to move his legs again. It's strange how these words can make a grown man sit as still as a well trained schoolboy.

I wander how he ended up - it's hard not knowing. Hopefully it was nothing but a bit of pressure from a swollen disk, or a pinched nerve that healed itself. There's always the chance that was the last day he ever walked, and I have to be open to that possibility no matter how much I dislike it - being honest with yourself is the only way to survive the job for a long period of time. I doubt I'll ever find out, but I like to hope maybe I made a difference by being there.

Can't we all just get along?

This post is something I struggled with for a long time in terms of how to go about writing it. It involves two organisations, both of whom are involved in emergency health care, one on a professional level and the other on a voluntary level. Let's call these organisations St Peter Ambulance and City Ambulance Services to ensure that you realise I'm talking on a hypothetical scenario ;)

Now I'm well aware that there are members of St Peter Ambulance (StP) who probably shouldn't be allowed within a 100m radius of a patient. Still, they somehow slip through the cracks of screening (a problem associated with volunteer organisations) and end up on the wrong end of a pair of nitrile gloves. The wearing end, that is. Still, overall I would say that the members of StP are competent and professional in their conduct, are highly trained and motivated people giving up their time for a good cause.

I could understand, however, why some members of City Ambulance Services (CAS for short) might have some problems with some of StP's members and their conduct in potentially dangerous scenarios (such as extrication with severe trauma, certain drug episodes and other events requiring extensive medical knowledge). Sometimes this gets taken to an extreme, and unfortunately everyone suffers.

At a major music event somewhere in Australia some time ago, the members of StP's were informed by CAS that they were under any circumstance allowed to move a patient, and that this must be done by CAS. In addition, the StP's 'acute trauma unit' staffed by Doctors and Nurses wasn't to be used if the patient couldn't walk to it unassisted - they would be taken directly to hospital again by CAS. The event had multiple performance sites with crowds in the thousands, StP's in the dozens and CAS's by the handful. Unfortunately, CAS were under equipped and were forced to borrow StP's gear and had insufficient 'buggies' to move patients from site to site.

Two conflicts were (hypothetically) created from this scenario - the StP's were, for the most part, unable to perform their duties fully with the restrictions in place, and the CAS members were run off their feet trying to move people from site to site or to hospital for things that the StP's and the StP trauma unit could have treated.

I won't comment on the origins of this hypothetical situation, but I will say this: the day was made significantly harder than it needed to be because two organisations couldn't play nicely. Blame lies on both hypothetical ends and, unfortunately, it's the patients who suffer because of it.

Situations like this - and it's not the first one I've hypothesized - are one of the many things that are wrong when various health care organisations don't play nicely.

I know we might not always like each other, but come on people - can't we all just get along?

Living in the darkness...

It's a funny thing being cut off from the internet (or, as I affectionately know it, the Life Source or All-Spark *ba-dum-tish*), but since leaving my previous job, being in a clinical trial and getting myself organised for the move to Sydney I haven't had a chance to get online!

So I've decided that until the situation becomes stable again, I'm going to write up posts from home, then upload them when I get a chance. This means the number of posts should remain consistent, but that most of them will be made in big spam-like posting sprees.

Don't worry too much, it's only till March 17 (the details on that later!).

A big problem

This might be a bit of a touchy subject for some, so I'll start it off by saying that I don't mean for any of this post to be offensive - I'm simply stating the problem as it is and the ramifications of this.

Today's society is fast paced, with less and less time available for the little things in life. Unfortunately, good nutrition as part of a balanced diet with exercise is often left out of the our lives - coupled with an increase in access to quick, cheap fast food, it's not surprising to see that over 50% of Australians are overweight. The reasons for obesity are vast and varied, and it's not a topic I want to go anywhere near right now.

Obesity places many drains on the health care system, with rates of heart disease, non alcoholic fatty liver disease, diabetes and other obesity related illnesses rapidly increasing and showing no signs of slowing down. But even before these long term, usually late stage effects, the drain is felt on th health care system.

Paramedics are often left with no way to safely treat or move obese patients. On top of the physical exertion required and the dangers of a morbidly obese patient injuring you or being injured themselves during transport, the equipment designed for us simply won't hold such excessive loads. In response to this demand for stronger, sturdier and more durable equipment, new designs for high capacity equipment is required - some universities have even been asked to design specialised equipment as fourth year engineering assignments!

Beyond that, it's costing ambulance services millions of dollars for specialised 'heavy duty' ambulances - last year the ASNSW alone spent $600,000 on three trucks to carry patients over 160kg (the weight restriction on the standard ambulance), with another two trucks on order. Specialised beds for the obese cost $30,000 each for hospitals.

In Victoria, MAS has even gone so far as to request the privatisation of ambulances for the obese (in Australia almost all ambulance services are non-privatised), a move unions are currently trying to block. But is it such a bad idea? Often medical transport is all that is needed, with paramedics being called in due to the excessive weights being loaded. The patient is made very uncomfortable during lifting, with stretchers often too small or not designed for that capacity, the patient also receiving a massive blow to their dignity and efficacy as they are often sighted by curious crowds in such a state, having a massive impact on their treatment outcome. Such vehicles and equipment will be in high demand over the coming decade.

But as it is, the ambulance service cannot afford to purchase more.

Privatising this service would allow paramedics to be freed up for emergency medicine (something they're known to take part in from time to time between drunks and headaches),
allowing the trained patient transport officers - with their specially designed equipment - to give the patient the transport they require. Naturally the ambulance services will also require some vehicles and equipment of their own for emergency cases involving morbidly obese patients, but the drain on the public health care system will be decreased with no impact on patient care.

I'm particularly keen to hear what you all think of this, so please drop a comment.

They had best not win...

I'm jumping on the bandwagon of bloggers currently posting on the suing-of-the-paramedics topic currently happening in the UK - original article here.

Some posts I highly recommend reading are from Random Acts of Reality and Nee Naw, which sum up my thoughts on the matter exactly (also means you should go read them and save me having to rant ;P).

This is one of several problems that I'm scared we'll start to see more of in Australia - one of the reasons I've chosen Paramedics over Medicine is that you are less likely to be sued (others include how stretchers in the US are now being redesigned as patients are too 'large' for them, increased levels of abuse of the EMS services and an increase in drug induced psychosis and aggression - more on these at a later date).

One thing that really surprised me about the article is that ambulance crews are expected to rush into dangerous situations where their life may be put on the line - but in reality we're taught to do the exact opposite. The very first thing we do on arrival of an unknown scene? The primary survey - DR ABC. The D is for Danger. If it's dangerous to us, we don't proceed, because otherwise you can just end up having to call in more ambulances to treat injured (or worse) paramedics, these days ambulance services are short staffed as it is - just read this to get an idea.

Final words - have mercy on paramedics (including don't sue). It's an underpaid, overworked, sweat/urine and feces* filled job - but one that wouldn't be traded for anything else in the world, and you'd be lost without.

* Urine and feces usually not ours

Rage Support Group

I'm sure many of you are wondering how Rage Against the Machine went... Let me paint you a picture.

We're standing in Festival Hall, the crowd has swarmed in like a hive of angry hornets. The air is thick with sweat and cheers as the band finally appear on stage. The first riff hits.

As if from nowhere, a dark portal shimmers into existence. We can hear the wails of a million tortured souls and people who don't like puppies. As the portal grows, covering the entire crowd, a light appears from the center, a pinpoint at first but growing, feeding on the darkness we see the fires of hell. A clawed hand emerges from the fires, pulling itself further into our domain - the wailing increases until blood drips from our ears. Satan, the Dark Prince pulls himself free of the fiery gateway, a trail of burning flesh marks his wake as he slowly moves towards our post. Gripped with terror we stand, unable to move as the Fallen One moves towards us, fire burning in his eyes and a dark grin spread across his mouth, his pointed teeth just showing. He arrives at us, still stunned, leans over so that he is just inches from my face and whispers, almost mockingly to me.

"Just kidding."


Despite our fears, it was an extremely quiet event for us, the crowd was amazing in how good they behaved. There was the usual moshing, jumping around and people getting hit by a few stray elbows (and one poor fellow copping a bite to his head while moshing - another copping a head to his teeth), but apart from that I was impressed. To give you an idea of the situation, at one point I saw two guys walking in opposite directions collide, one spilling half of a just poured large beer. I tightened my grip on my kit, expecting to have to go in and treat a punch up, only to see the two guys look at the beer, shrug shoulders and shake hands!

One should never complain about being pleasantly surprised.

Rage Against Anyone But Me Please

This post is a preemptive post. Tonight, I head to Festival Hall for the Rage Against the Machine concert with St John.

Following some events from the Big Day Out, we're expecting a small piece of hell to break loose.

Should be fun. We've brought in extra members, equipment and vehicles to cope with the potentially rowdy crowd - here's hoping we can keep some of it under control... I'll be sure to post tomorrow morning to let you all know how it goes.

Operations

I came to my St John division in 2006, having never been a member of St John before. At that time, the division was being run by people who did a good job of it, but it was obvious to all that they were overworked, tired, pushed too hard by the organisation and were on their way out. Who can blame them – we’re volunteers… But that's a story for another day. About six months after I joined, I had well and truly fulfilled the required annual hours service as was well into making a name for myself as a ‘regular attendee’ at several duty types and loved working as a First Aider. Suddenly, there was a massive change in the administration of the division, with the Operations Officer pretty much leaving due to his work/study load and the acting Divisional Superintendant transferring to another region. Things were not looking good for the division.

I put my hand up to help out with the administration side of things until everything got itself sorted out – unfortunately I was thrown into the deep end and had to quickly learn the ropes. 10 months down the line, I somehow became Head of Operations and Training for the division.

Operations is a time consuming, frustrating, often painful and always annoying role to fill. Ask any Operations officer in any division (in pretty much any organisation), they will all say that this role easily consumes more time and effort than that of a Superintendant – you are more likely to be mistreated, abused, woken at odd hours and working the most duties compared to any other role in the division – the only time you don’t get yelled at is when everything runs smoothly. Thanks are few and far between.

But it's important that you don’t let this scare you off. It isn’t a glamorous role filled with perks – but it is definitely the most rewarding on a personal and organisational level. Although your division may not always notice or show it – your stature within the organisation does not go unnoticed amongst regional or state staff, and it is a brilliant way to make contacts within and outside the organisation which can be used in many other aspects of life. The feeling of having everything run smoothly is comparable to nothing else, the constant challenge of achieving that makes for a perfectionists dream. You learn that when nobody says anything, you’ve done everything perfectly – and that’s all the thanks you need.

Operations is still a very rewarding and fun role to fill, despite anything else I may have said so far. You have a ball with the members, because unlike other roles Operations is a role that requires you to know quite well each member so you can appropriately allocate them. But it’s hard not to know someone well and not become friends, so after even a brief stint in Ops you’ll have made friends that may very well last the rest of your life – this alone is a reason why it’s such a rewarding position and one I feel I'm lucky to have held this long.

What's sticking out of my arm?

Well so much for the bonus posts given I was in the trial... Turns out the internet is a hard thing to get a hold of in there when there's a bunch of people with nothing else to do. The good news is there's at least a few good stories from the event.


This is my arm. The thing sticking out? A cannula. The red stuff? My blood. I was participating in a Clinical trial. If you're not reading the link, it's the method by which developed drugs are tested on humans for research and developmental reasons, which play an important role that often gets overlooked by the public unless something goes horribly wrong. Which, fortunately, it usually doesn't. Which is not to say the drug is always a success - or even successful at what it was originally supposed to do, yet certain 'side effects' were noticed that allow for a continuation of trials (thus Viagra was born).

I volunteered to participate in a Stage One clinical trial for a new anti-arrhythmia drug - fortunately the initial screens had been done with no side effects and the study operators were just wanting to know the kinetics of the compound (how long the drug stays in your system for after taking it). Many people (my poor mother included) would hate a loved one being involved in such a potentially dangerous scenario, however it does offer the participant a rather large sum of 'financial reimbursement for their time' which equates basically to quick, easy cash. Those who are aware of the risks might even use such an event to fund a move to Sydney, for example.

The thing that frustrates me more than having to spend 3 days in bed with no chocolate, coffee, tea or other happiness inducing substances is that although the trial runs for a total of fifteen days distributed over two months, it pays me more than my PhD stipend would working full time (and then some) for three months.

Can anyone else say 'Highly educated people working as slave labor'?

Well not anymore for me, at least. I finish in the labs at the end of this week.

He DID!

Short but sweet - the results of my medical have come in and I got a call today letting me know that I was 100% confirmed in - my acceptance letter and request for accommodation on base are in the mail!

Like you ever had any doubts ;P

I did...

In other news, I'm enrolled in a Phase I clinical trial where I'll be bed ridden for quite a bit. It's ok - I will have internet access so expect a few 'bonus' posts. They might be long.

I also look after fools and drunks

I was with St John (as I'm known to be) at a local event where the crowd was happily served copious amounts of alcohol. While I usually dislike these events for the obvious work it provides me with, the crowd were actually a pretty good group of people all out for a nice fun time.

Of course, for two of them, the day after may have been slightly less so. Actually, for more than two - but let's just say these two in particular ;)

The first was a girl who had consumed her fair share of beer and then a little more. After that she drank herself silly. Thinking this might be a good time to head outside and purge her sins, she told her boyfriend her intent and strode forth into the night. After some time the boyfriend (who had stayed inside the warm room filled with friends) got a little worried, and before long we were called to an unconscious female in the garden.

On a side note folks, why always the garden? It's full of prickles, thorns and bugs - please, please try to pass out somewhere a little more convenient for me to get you from!

While she wasn't at the point of needing her stomach pumped, she certainly needed to sleep this off. Her boyfriend and a few friends were with us, which made my life a lot cleaner - I got them to hold the em-bag while she continued her projectile ways. The unfortunate thing for me was the fact that her location was completely inaccessible by vehicles (such as the one a friend was driving around to take her home), she was a large girl and was in no state for walking.

Out comes my best friend, the scoop stretcher. If there is one piece of equipment I recommend all first aiders get - it's this. We load her into it, secure her and (with the help of myself, a partner, the boyfriend and three other friends) take her over to the car. There was a bit of a wait, so we released her from the scoop and we sat around talking for a bit. Although drunk, she was a lovely girl and liked my sense of humor - this was also a good thing because I love an audience. A captive audience best of all.

After a few stories, jokes and musings she said something to me that I doubt I'll ever forget - "You're good at this." For some reason that simple statement made by a drunken girl sitting on cold concrete with a half full em-bag in her lap remains one of my warmest, fuzziest memories of first aid. I felt like, in my own small way, I had achieved something that night. After a bit the friend appeared and we got her into the car for her adventure to continue while we headed back to our designated spot.

A year later at the same venue and event (it runs every year) I met our second drunk. We were called to her under similar circumstances as our last friend, out in the garden 'unconscious' (of all the calls for 'unconscious' I've had, only around 5% of them actually are unconscious...).

Seriously - stop going to the garden, people.

Unfortunately this was the one time of the night when all the people requiring first aid needed us at the same time, so I was caught between treating her and also inspecting a young man who'd recently been in a fight. Luckily they were scant meters from each other, so my life was made somewhat easier. The girl was GCS 3,5,6 - but the 5 was borderline 4 depending on which time you roused her. Drunk girl this post, fighter in a later dedicated post (oh yes, it was a good one).

We got her into a stretcher (I had learned from last year), covered her in a nice thermal (foil) blanket/wool blanket combo and were wheeling her over to the car park so she could get a taxi to her friends place. She probably could have walked, but she was a very petite girl, continuous going 'floppy' and thus was extremely difficult not to drop - I was erring on the side of caution. I was also using this as a way of getting away from the 'fight scene', but again more on that later.

The girl was great when she was talking, a very giggly drunk and rather entertaining actually. While I couldn't stand it all night, a 5 minute stroll was quite enjoyable. The big laugh came when we approached the taxi area with the girl in a stretcher and, unsurprisingly the taxi just took off. We sat her up with her friends to wait for the next taxi with her thermal blanket still around her ("You look like you're about to be thrown in the oven!") and left them to the night. I was proud of the partner I was with, as it was her very first duty and she had handled herself well (which I of course told her), and she said she was impressed with all of our friendliness and humor and was keen to do more duties.

I heard through a friend of a friend that the girl made it back safely to wake the next morning still wearing the thermal blanket - but didn't remember how she got it. It's always nice to hear how our patients have recovered - better still when it can give you a chuckle.

Not there yet...

I've mentioned it in a previous post, but it feels time to go through it again due to the simple fact that I've re-read some of these posts and have realised how caught up in it all I've been.

Despite my hopes and ambitions - I'm not a Paramedic (yet).

A friend pointed out that a lot of my posts seem to be narrated as if I had reached that goal already, as if - when talking about Paramedics - I'm relating more as a peer than a student (who hasn't even started at that). To me, this is dangerous territory and something I think I should address sooner rather than later - for my own sake if nothing else. I know I'm nowhere near the level of Paramedic, and the things I've seen and done as a First Aider/First Responder are probably trivial events to the average 'ambo'.

My true challenges lie ahead of me, and I cannot afford to let myself think I am prepared for them yet, because it's the Paramedic (or Doctor, Nurse or even Barista for that matter) who is over-confident that makes mistakes, misses details and generally gives the rest of their profession a bad image. I don't want to fall into that category. Ever.

But to address the issue of relating on a personal level as a peer - in a sense this is something I probably won't stop, not due to the fact I feel as qualified as them (which, believe me, I don't) but for the fact that they are just normal every day humans. Yes - even just like you. They're just trying to do what they can - and to that I relate. I (think I) know how it feels to be doing something that is important to someone's life and health, I know how it feels when it's working, when it's not. When it fails. When it doesn't, and the clouds open up, the sun shines through - and I like the sun, it makes me hopeful. Most of all I know how it feels to want to be better, for their sake - then for yours.

I know I'm not there yet... But I will be.

About Chiron

A friend of mine who reads this blog recently emailed me asking what the whole 'Chiron' business was, so I thought this might be a good time to explain.

Chiron was (in Greek mythology) a healer, teacher and oracle - which, when I decided to take the path of paramedics were what I felt the three main aspect of the role were about. The wikipedia article regarding him will give you a much better background than I can in this blog (there's a few points I'd put differently but it is a good summary - go on, give it a read!), but suffice to say that in my journey from a medical researcher to paramedic I felt I was following the ideals and philosophy of Chiron.

I have a sweet spot for mythology... But back to the three foci - Healer, Teacher and Oracle.

Paramedics are, first and foremost, healers. They travel to those who are in need or pain to heal. By no means are they doctors or nurses, also healers, but they do play a vital role in the health services - one which I've felt long before I wished to become a paramedic was a vastly overlooked and under appreciated role.

But paramedics have one major advantage over their doctor/nurse brethren - they're constantly out in the community. Unlike the hospital or clinic bound others, a paramedic is free to roam the vast plains of... well, the roads... and actually interact with society in a way that only a paramedic can. 'But with great power comes great responsibility' - damn you Uncle Ben... Given this role, the paramedic is also a teacher. When examining patients in a public area, when out and about, when visiting a school or when providing (or even teaching) first aid, the paramedic will be asked questions on health care that they are in a much greater position to answer than a doctor or nurse simply because they usually have the time and audience to make answering the questions worthwhile. Really, paramedics should have 'the golden title'... But that's a rant for another day ;)

Finally, a paramedic has to be - in a sense - an oracle. Sounds a bit silly, I know - but given the nature of the role a paramedic must always be trying to stay the step ahead of what could go wrong - because as Murphy taught us, whatever can go wrong, will go wrong.

It's this strange combination of the three attributes that has brought me to the field (coupled with a strong sense of spontaneity, the constant mental/physical challenge and the fact that you never quite know where you'll end up or who you'll be treating). I was asked during my interview (and by family and friends) why I wasn't going to study medicine (to become a doctor) given I had an highly academic background and they were shocked that I couldn't have thought of anything worse.

Sure, there was a higher likelihood of being sued in medicine, the extra time, debt and financial hardship associated with another 6-10 years at university, but more than anything else it was the fact that I didn't feel medicine would provide for me that sense of 'teacher' and 'oracle' that I felt paramedicine would. I wanted to connect with my patients (which as I'm sure I'll get emailed about - isn't always a good thing) and to do something a little more 'free' from the confines of hospitals and business suits.

But back to Chiron - when I decided to chronicle this journey I went through several possible names for the blog, but none of them felt right. I tried to have a slightly comical sound to the title (I'm a big fan of 'Blood, Sweat and Tea', for instance) but felt it somehow that it lost a part of the seriousness or determination I held for obtaining the qualification.

So I went back to my roots, thought about how I truly felt about the role and there it came - Chiron. I was in pursuit of his teachings and philosophies.

I was Following Chiron.

Calling all Australian Paramedic Bloggers!

A quick shout out that I'm launching a new Australian Paramedic blog syndication called 'Stretcher Marks'.

Check www.stretchermarks.com for a preview - bearing in mind that it's still in its infancy and a lot of work will be done over the next few days/weeks...

Email followingchiron@gmail.com if you're interested in participating!

Don't tell lies

There is of course another side of the coin when it comes to my last post. I like to think that omitting information (or flat out refusing to give it) is more of a deficit of honesty more so than lying, so I bundled some of those examples into that post. Some people, however, just flat out lie. Not through omission, not to save their skin - they just lie.

Several cases in point; at a recent festival a member of the public came to my post and reported an unconscious male locked in a bathroom cubicle. On goes the response gear - a giant pack filled with Oxygen, breathing apparatus and other gear on me with a response kit complete with trauma gear and defib for my partner. Not the easiest gear to carry but we do it without complaint or question - it's the gear we need to do our job. We make our way around the corner to the bathrooms and I check every damn cubicle - all of them in use and filled with an angry male wanting to know why I was banging on the doors. Nobody else had seen our supposed unconscious male, and some patrons had been waiting for a cubicle for quite some time.

Now, I'm not afraid to go on a wild goose chase ('That's what wild geese are for.' - Anon), because I'm fearful of that one time we don't go when we are needed. But why would someone make up a story like that? It got the reporter about three seconds attention from us but wasted about fifteen minutes of our time. Time that we had to mark ourselves as a response crew as 'responding and unavailable'. At this event we had a rather large amount of drug OD's - and they wasted our time on this? But sometimes it's not the reporting of a patient that's the lie... Sometimes we have something much more fun in store.

And these are the cases that really irritate me - people who have nothing wrong with them, but they insist on treatment. These are the teenage girls who've 'fainted' at concerts, the patrons who travel around first aid posts at large events getting paracetamol from each post (we usually catch them out, but unfortunately they can get as much as 3mg before the flags get raised), the hypochondriacs who insist on us calling an ambulance for their 'broken leg' despite walking in with no problems only to find out this post doesn't stock penthrane.

It's the active lie that can do much more damage to our patients, ourselves and our work. I can understand sometimes why people might lie - the elderly or homeless sometimes just want someone to talk to, youths often just want attention and sympathy, addicts might want to score a pain killer when they have no money - and this is one of the things that worries me most about emergency medicine. You see, the problem with medicine outside the hospital (and even in many cases inside) is that we have little in the way of diagnostic equipment. For this reason EMS is rarely allowed to diagnose patients - but it's still a big part of what we do. So how do we go about doing this without said equipment? We have to depend on the patients complaints and symptoms to guide us.

For this reason the homeless will get their night in A&E in the warm bed, youths will get their attention and yes, addicts do score free pain killers - because we have to trust them and their word, because some times there is little else we can do.

Rule 1 of Emergency Medicine is everybody lies.
Rule 2 is supposed to be 'Never forget Rule 1'.

I sometimes think a much more appropriate rule 2 would be 'Know when to forget rule 1'.