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.