Things you might not realise...

We all know there are risks associated with obesity which will seriously impact on your health and quality of life, but something not many people realise is that the problem goes beyond your life and into your death - and our attempts to return life.

I've had a few cardiac arrests now where the patient was morbidly obese and the outcome each time has been a non successful resuscitation. In addition to all of the associated health conditions of morbid obesity leading to an arrest, there are a few points you might wish to ponder...

Many morbidly obese patients are confined to chairs or beds, which is where we usually find them and are forced to try to move them to the ground before effective resuscitation attempts may begin. This can sometimes be an impossible task - anyone who has had to carry a slumped body will know just how heavy and awkward it can be, but when the patient is at an estimated 190-200kg the task becomes almost impossible. While at least 2 ambulances are always dispatched to arrests, it is usually the first ambulance with usually 2 officers who are forced to try to make this move, and while occasionally family, friends or bystanders can assist the danger of injury placed on the officers is sometimes so high that they are forced to wait for more help before the move can be made. Sometimes the patient will already be on the ground, but if the patient is on their side in a confined space or simply has too much mass to effectively roll, the result will be the same - decreased effectiveness of chest compressions which will further reducing the viability of the patient.

Of course, even once the body has been placed in an optimal position a morbidly obese patient may not receive effective chest compressions due to the additional adipose around the chest. With some obese patients chest compressions, although placed correctly with the correct amount of pressure, result in the heart being moved 'side to side' rather than compressed and effectively pumping blood to resume circulation. Sometimes it is simply not possible to achieve the correct amount of chest compression with the chest being significantly thicker.

Airway access is also significantly more difficult and ventilation harder with the bulk of the body decreasing lung inflation. Cannulation becomes more difficult which can delay IV drug administration, and one of the greatest tools of resuscitation - defibrillation - can be less effective with decreased conductivity to the heart due to the additional impedance. While many defibrillators will detect impedance and attempt to adjust the current delivered with each shock, there is only so high the machine can go before the risk of burns and electrocution to other organs becomes too dangerous.

Should resuscitation be effective, or the patient is producing enough of a viable rhythm to be deemed by the paramedics transportable, there are then issues of moving the patient to an ambulance stretcher capable of bearing their weight. In NSW we have stretchers rated to 160kg and 180kg, with patients higher than that requiring the use of a custom built vehicle for bariatric patients. As there are very few of these custom built ambulances, there can be considerable delays from when the initial ambulance arrives to confirm the arrest and to call for the vehicle to when it can arrive on scene with the required equipment. These stretchers also require a large amount of room, and specialised lifting equipment with up to 10 ambulance officers sometimes being required to lift the patient can delay loading times. Once the patient is at hospital there will be issues in transferring the patient to the hospital bed, with resuscitation sometimes continuing on the ambulance stretcher due to necessity. Of course, all of the other issues listed above still continue, with potentially decreased effectiveness of CPR, manual ventilation and defibrillation.


None of this is to say that the efforts made by paramedics, nurses and doctors are any less than for any other patient - regardless of the age, race, gender or size of the patient our efforts are always to the best of our abilities to provide the patient with the best chance of a viable outcome. Every patient deserves compassion, respect and care - every patient and their family will have fear, feel grief and loss. But sometimes we know what the outcome will most likely be, and that the factors involved will decrease the chances of that outcome being positive and we will attempt to prepare the family for this fact.

When people see us arrive at an arrest they gain hope that their loved one might be brought back - that they have another chance of taking another breath.

Sometimes they don't.

EMSPA (NSW) Inc.

Lately I've been caught up working for EMSPA (NSW) Inc., an Assocation of Emergency Medical Service Men and Women fighting for the rights and legal protection of their peers.

Suffice to say this has kept me very busy, but has been a very rewarding and educational experience for me. This experience has also made me VERY grateful for my time spent with the Biomedical Society, which at the time was a fun almost hobby like activity - now many of the same principles and legalities are applying (with of course some alterations), the Association is run by Committee and I feel much more at ease with the way things are done thanks to the previous experiences.

Which makes me glad that I took the time when I was younger to do these sorts of things... I tend to be a real work-a-holic, always trying to keep myself flat out doing SOMETHING - at times the weight has made me tremble but so far I've held steady. I've learned my limits - although I push them from time to time to see if they're still there, and it's only when I look back do I realise that by the age of 23, I've already accomplished things that make me proud of how I've lived my life. And I only plan to achieve more and more before I'm ready to hit the grave.

The biggest lesson I have to learn is to take more time aside from WORK to SOCIAL... But more on that another day.

Smile! EMSPA has your back, Brothers and Sisters - and we're all dedicated as hell to make this work!

All things must change

Months since the lost post here, much has changed.

Firstly, the job has changed. Where I used to wake terrified and excited each morning, wondering what jobs would come down and if I would be able to handle them, I now wake tired, never feeling like I get enough rest and looking forward to the next set of days off, which seem few and far between.

Not to say I don't still love the job - the excitement still gets me and the adrenaline can still get pumped through my system several times a day on the good days, but the bad days are now more monotonous and 'auto-piloted', as if my body and mind lie in wait of 'the next big job'.

Where once I would have a slight tremble in these 'big jobs', despite knowing exactly what to do and be doing it, my hands are now calm, still - my mind sure and planning at least two steps in advance. I've approached major overdoses, CVA's, respiratory distress and cardiac arrests all with the same confident, calm approach that once seemed so comical about the profession but has now become a stable flow of my life.

The wife is frantic, her husband having overdosed on many tablets of tricyclic antidepressants, his ECG shows things are not looking good and his level of consciousness is dropping with each passing second. She runs at him, grabbing him and trying to 'help' move him to our stretcher. I calmly pull her off her husband, force her to face me and not him, tell her how she can help by finding the empty medication wrappers, let us look after him. My partner and I position him laterally, maintain his airway, oxygenate and load him into the Ambulance. The wife has left us, running from room to room as if she can hear the packets calling her, but she cannot quite work out where they are.

Secondly, I have changed. I still make the bad (good) jokes, smile frequently and small talk, but the naievity of my youth is now long gone and I can't help but feel somewhat colder inside. I realise how little of my youth I took advantage of, partying little and studying perhaps too much, and while I know technically I'll still be a youth for several more years I feel older - aged beyond my time. But I am still happy, loved and in love, if anything now appreciating more the sheer preciousness of life, so easily lost, so easily wasted and so easily enjoyed and cherished - made more than just time on this planet, an experience to hold dear and utilise to it's most full. 'On job' I comfort and counsel those who have lost, those who are losing and those who fear for their loved, I show sincerity and understanding and have been told I'm good at it - but it feels as if it comes from someone else, some other source, because in reality I am cold inside to steel myself from the emotional aspect of the daily onslaught of misery we face, and must face.

The wife is crying, sobbing into her hands. We are prepared to leave the scene and she steps up into the Ambulance passenger seat. She was unable to find the medication packets and again feels a failure and powerlessness that only someone watching a loved one dying can ever understand. I tell her that her husband is in a serious condition, but that we are monitoring him closely and will have him at the hospital shortly for definitive care. I comfort her best I can, talk with her to find out more of the details of what had happened, the little facts that at first don't come out but can drastically assist treatment. I weigh our options; try to look myself for the packets, further delaying transport but perhaps having a better idea of what we are up against, or transporting knowing some of the story but getting us to hospital quicker, where many hands make stabilising this patient much easier. On arrival the patient was talking, albeit nonsensically, but now he is only responding to painful stimuli - even then only with much effort. I decide to go with the latter, and we pull out of the driveway.

There is a dangerous balance in this job. Care too much and you can't seperate yourself from your jobs - the misery consumes you and the sheer weight of suffering crushes you. Care too little and you seperate yourself from your jobs completely - you become too cold, burnt out and resenting the patients more and more each day. The balance varies from day to day - sometimes you need to care too much, remind yourself that you are human and the importance of the decisions we make between seconds that can save or damn a human life. Sometimes you need to be cold and untouchable, shield yourself from the onslaught. As long as you can find that middle ground again, survive and endure.

We arrive at hospital and rush him into a Resuscitation suite. A frenzy of bodies, hands, minds and tools check vital signs, draw bloods for analysis and ensure the body stays ventilated,the heart beating sufficiently. The wife is moved to the waiting room for what will be the longest few hours of her life.

The world has changed. Or at least, my understanding of it has. This 'first world' country is far from it. The addage that a person is smart, but people are stupid takes on a greater understanding and the acceptance that people do very strange, often stupid things in 'emergencies' is made. People live in squallor. People live in filth. People live in luxurious mansions with bedcovers that cost more than I make in a month. People have children, children have children. People make mistakes. People get hurt, get sick, get old.

People die.

I always knew about and understood death, but there is a familiarity you make with it after many encounters. There is an essence to it, a feel that cannot be described or conveyed. Sometimes even an anticipation en route to the scene, somehow we know what we will find.

The wife has gone home, although I doubt sleep will find her tonight. Her husbands blood still moves around the body, oxygenated and delivering nutrience to the organs. He is to be transferred to another hospital for acute high dependancy care, although his outcome remains unknown.

We have finished our paperwork, submitted the report to the hospital and move back to the car. We push the little button to make us 'Available' again, and we await the next job. As always we don't have to wait long, and a siren wails off into the night, the previous job cleared from the mind as routines, protocols and plans are laid for the next patient.

All things change, but for now I know where I am in life, where I am going and what roads lie ahead. 

And I am happy.

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.

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...

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.

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?

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

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.

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.

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'.

Did he or didn't he?

I sat at the table, three highly trained Paramedics in front of me. Their uniforms were clean, sharp and all said one thing; we are professionals. I was nervous, but ready for this.

My palms were slightly sweaty and I hoped they wouldn't notice. For an hour we danced our little interview dance, throwing questions and answers back and forth. Of course, at the time I could have sworn I'd been at that table for five hours, but in that little room it was irrelevant. Only the types of questions asked could be used to mark the passage of time. Every now and then I'd throw in a small joke or remark but only one would ever give a little giggle before the cast iron mask came back down - but that was enough, I knew they too were human (or at least I had suspicions) and that I could do this.

And I did.

But it wasn't over yet - next came the driving test. While the interview made me feel like I was there forever, the driving test seemed to be over before it began - and the instructor seemed happy with me. That $50 note could stay in my pocket, then...

We moved back into the Ambulance Training Center where I was sat down with one of the Paramedics who interviewed me.

"Kane," she said, "you've made it through to the next round. If you pass the medical check, you'll be a Trainee Paramedic with the Ambulance Service of New South Wales. Congratulations."

I was thrilled - there were no words (although I did gush out a 'thanks!') to explain how I felt. She laughed at my obvious relief and we discussed setting up the medical in Melbourne to save me having to fly back up to Sydney again.

I climb back on board the plane to Melbourne, we take off. For the first time QANTAS was the cheapest airline for the flight I was after, and lucky for me they do complimentary drinks.

I think I earned it :)