The son has left the building

Yep Christopher has departed these shores and returned to the southern island of Australia and his new share house and new job.

His mother is holding up as best as can be expected and I hope for a lot of compensatory attention now that he has gone.

We have been left a trail of Coke bottles, most with something still in them as a parting gift.

This is a photo of Chris walking his mum to 'down the isle' as such on our wedding day in 2004.




Be careful out there and I'll see you at the Big One.

Taz

Changes to the posts.

The natives seem to have been whispering again but not to me, they never seem to be able to do that. The boss and I had a discussion about the blog today and I have happily made some changes.

I have dumbed things down even further and fuzzed up were I am, or have been working and removed the unidentifiable photos of the knee (they weren't that good really) along with a few posts that made no sense after trimming. I have also included the newspaper page that is PUBLIC RECORD of the first VT arrest were it also names both officers.

Maybe that will keep the silent censors happy.


Be careful out there and I'll see you at the Big One.

Taz

PTO or R7 transport bus today!

One back home from Hospital.
One from nursing home to hospital.
Etc, etc,etc

That's pretty much how it went for the day, that or refused transport.

Did transport a wonderful ol' retired gent who had fallen at home and cracked a few ribs. Wonderful man to talk to and full of knowledge about the area, I bet he knew where a few skeletons are buried too.

That was it for the second last shift with my current partner. Start up with a new one for a whole roster from Saturday, the same one I worked the last overtime shift with this week.

Chris leaves in the morning so we have been out for tea at the local pub. I'm full as a pig and ready for bed.

Goodnight and,

Be careful out there and I'll see you at the Big One.

Taz

It could happen?,,,,,,,,,,,,,,,,,,,Seems it could!

Thanks to the Professional who passed this on.

Be careful out there and I'll see you at the big bone.

Taz

Tuesaday night Overtime.

Only eight jobs for the night but I had the opportunity to do a shift with my new partner in the next roster.

1) Take an elderly man home.
2) Take a man to hospital after a work related injury.
3) While we're here we took over a day shift patient so they could knock off.
4) A young fella allegedly assaulted, but very very drunk as well.
5) A very drunk, very obnoxious, very disgusting young female who is probably very nice sober.
6) Near 60y/o with proper chest pain.
7) 29y/o fella with a very impressive dislocation of the ankle.
8) Take 'a discharge from hospital' patient to the domestic airport to catch a plane to his country home town.

Mother and Son went into the CBD to shop so I slept well. Talking of which I'm back on deck tomorrow on rostered shifts so I better bunk down early tonight.

Be careful out there and I'll see you at the Big One.

Taz

Can I work tonight?

The list of available stations for overtime tonight was like most of Sydney!
Of course I took my station. I still have Police statement to write about a job I personally did nothing on but drive and it gets my gear back there to start work proper on Thursday.

Be careful out there and I'll see you at the Big One.

Taz

Synopsis of the last three nights

On our first night we opened our account with a visit to a lovely old couple that live local to the hospital and whom I have visited many times since I was a probationer myself at Paddington.

The husband had walked up to the hospital to tell them that the wife had suffered a fall and could they help.

Triage called the ambulance.

They live in an terrace house with very poor access due to the quantity of pot plants they have on the front steps. The poor old luv had taken a fall in the doorway between the dining room and kitchen and couldn't get up and was C/o hip pain. I know she is a tough ol' bird so I got to with the analgesia and then with good planning we got her out.

Later that night I got the confirmation that she had done the NOF that I had suspected, she's 89 and funny enough, she looked the best I've seen her look in years, really healthy so this is a big setback.

There after it was the run of the mill stuff until an early morning police special, male assaulted.
It was in an unusual location for that kind of thing, residential, no parks, no pubs, no reason to be there unless you lived there, upwardly mobile people.

Nice bloke, 28'ish, walking home from a pub a couple of klm away when some teenagers also on the street asked if he had any smokes. He did, he shared and then they bashed him. No LOC he got up and continued to walk the bit extra to get home and then he rang the Police and us.

3cm Lac from the right lateral canthus that revealed the zygomatic arch, extensive sub-conjunctival haemorrhage, constriction of the right pupil and reduction of visual acuity.

He got a 2 second assessment from me at the door of the apartment and came straight to the car. A fresh bandage, some metoclopramide and a bat phone to the receiving to have a team waiting, ?? le Forte fractures possible intercranial haemorrhage.

Poor bugger, a really nice bloke, I do believe his story that he didn't give any cause to be bashed. A lot of them you know there must have been something they said or did to get in the fight.

Second night was the regular saturday night Sydney work. While there was some good work about my partner and I didn't seem to be in the right palce to jump the jobs.

But we did respond to a 23 y/o female unconscious who was having a bad trip after a few pills. the MDMA was really working her over, two rather large hotel security guysand I struggled to carry her out of the hotel she had walked into and then I had to jury rig some kind of restraint to keep her on the stretcher.

Now here's a point to ponder for the ASNSW people, can/should we use MRDs like posey restraints for pts that are not mental health. We use the posey's without any training??????

Anyway we waited for so long at hospital that the MDMA wore off and my partner got to see the change from the pt that she didn't want to be in the back with to this rational ordinary person.

Last night on the overtime at my old station, a steady night, a couple of police jobs that were not the usual crap that we go to and there were even a few sick persons that did require our attention and I was on the big bucks anyway so I'm not complaining about not really gettting any down time on my third night shift.

But I am buggered now, Tracy, Christopher and I have been and seen the new Indiana Jones movie. A great piece of adventure film and true to the other three, but I'm tired now so as always,,


Be careful out there and I'll see you at the Big One.

Taz

I'm doing three straight!

Night shifts that is.
So I will get to posting after I have recovered.
Christopher, our son, arrived today for a five day visit before returning to Tassie and his new job in the Tasmanian Police IT Dept.
Anywho, better go and get ready for tonight.


Be careful out there and I'll see you at the Big One.

Taz

Second Day.

Of course it's my day to drive today so as I have said before the patients were not mine to talk about. Enough to say that my TAO had a nice clean and not smelly day in which to develop her patient management and treatment skills.

BUT I do have the permission of the second last patient of the shift to talk about and use the photo below.

Called to:- Pedestrian verses Car, police on scene.
On arrival:- Pedal Cyclist verses Taxi passenger door.
On examination:- Taxi door is in fact buggered, stuffed, nearly pulled of it's hinge! The dumb passenger who flung the door open (the taxi was not pulled over to the curb, it was one whole lane of traffic out from it!!!!!!!!) was uninjured.

The biker a female of solid build took the impact on her right shoulder. A very localised pain with a contusion but no deformity or decreased ROM. No neck pain, helmet intact, etc bloody lucky.

The bike, not so lucky. It suffered a debilitating paralysis of the forward rotatory appendage requiring total separation from the main body.
I tried!

I really did!

But maybe this job just got too personal for me!

Maybe I was suffering flashbacks of Tracy's accident!







Nah, just taking the piss.
And so was I when I wheeled the bike into SVH with O2 mask on the seat and triangle bandage for the fractured front wheel.






It was just too funny and the looks from staff,,,,, priceless.

Friday night tomorrow,,,,, and I'm treating, wackadoo!!!!


Be careful out there and I'll see you at the Big One.

Taz

First day.

A very interesting mental health patient to start the day off. Friends had called the police with concern for their mate who has a history of Bi-Polar. He was just starting the quick slide into destructive depression and they recognised the signs, not bad for a couple of blokes? I know from my past experience with bi-polar in particular with my first wife that us guys are shit with this stuff.
If it was a broken arm or a scar or something we understand that but not these invisable diseases.
He chucked a couple of mad attacks at our local hospital, had the staff running around chasing him.

And to complete the day a very sick septic patient. Aged gent with dementia who, per family had just got worse since yesterday. Sounded like a chest infection gone bad. Febrile with shit BP and BBB appearing on the ECG en route. We got a resus bed straight up and thank you to the other crews who let us jump the queue.

Well that'll do, I'm off to bed. Tracy is recovering from the prang yesterday. Scabs are formed and the pain has decreased but she is still stiff and our son is coming for a visit from Hobart on Sunday so she will have to be better for that after all even aged 20, Christopher is still her little boy.

Be careful out there and I'll see you at the Big One.

Taz

Oh and the Broadband issue!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Telstra turned up with a new, faster modem because the one they had supplied was at fault. Or so they say.
Time and reliability will tell.

Be careful out there and I'll see you at the Big One.

Taz

Last day of rest.

Jesus, one single call for overtime up until today and I had to knock that back because I was booked to give platelets and plasma at the Red Cross and then a mid-morning call today for an arvo shift today which of course I can't do because I'm back on tomorrow.

So I started to make a few more of the TAO books and a new class started either last week or this and then Tracy wanted to go for a short ride. While negotiating a round-a-bout she had her first stack and it was 'SPECKY'!!!! (sorry I told her I would use that after my appearance on Bondi Rescue). A over T over the handle bars. Skun knees, big graze on the left elbow and a very dented ego. My wife's tough and I think this may be the worst injury she has had since childhood.
We walked out the corked thigh before getting back on the bikes for a slow ride home and some TLC and wound cleaning and dressing. Lucky I'm qualified to do that much!!!!

I contacted ASNSW Media yesterday about the VT arrest and a ZOLL watch and when I send them the details they will arrange it for me. Some one had already told the Boss about it so I missed out on bragging rights.
With our rosters now confirmed for the next roster it turns out my uni exam is between my nights so it looks like I'll have to have a deferred one??????

Well that should be enough, better get some sleep to be rested for tomorrow.

Be careful out there and I'll see you at the Big One.

Taz

Now what happened Friday the 16th!

VT arrest and a save!

Friday 16th May, a call was received for a 65 year old female from an eastern suburb with chest pain. The job was tasked to us, with P1 Taz Rundle and my brand new TAO who was on her third shift having graduated from the AEC exactly one week prior.

Patient contact was made inside a private residence at 2233 hrs with the patient, her husband and grandson all present inside the master bedroom. The patient stated she had experienced a rapid onset of central chest pain (‘it felt heavy’) with several episodes of vomiting and one of diarrhoea.

Something was making my diagnostic bump itch so I went straight for the ZOLL M Series defibrillator monitoring dots and after applying these I continued with history taking from the patient. Almost as soon as I had commenced this, the defibrillator tone went ‘wild’ and I stole a quick glance before returning to the patient to see her begin a hypoxic seizure.

Somewhere in the next 30 seconds my partner was instructed to ‘get me some oxygen quick’, connect the defibrillator to the shock pads that I now have on the patient, get the grandson out of the room (he would have been all of seven years) and we still have to get the husband to let go of the patient! I must have called for ICP back-up with something like ‘my patient is in some kind of funny rhythm’ or something like that, yeah the sphincter was quivering!!!!!

Analysis showed the patient to be in a shockable rhythm VT in Torsade de Pointes and a single 150 joule shock was delivered at 2236 hrs. No further shocks were delivered and CPR was commenced briefly < 2 minutes until the patient looked directly into my eyes and told me she must have fallen asleep and now felt better. GSC = 15 but amnesic of the event including me doing CPR on the bed (it was one of those bedrooms, no space around the bed).

God bless my partner, she got the bed ready as I had asked,,,, all the way into the house, so it was grab the gear, slide the patient off the bed stand, swivel and sit down on it and meet the IC as we are exiting the house.

It was my first cardiac arrest as the senior officer.
It was my first cardiac arrest with a TAO as a partner.

(maybe more of my prodigious prose may be used by the papers if this job gets published, which it should ,media love a good story)

And I think we did a shit hot job without any Intensive Care Paramedics.

It was pointed out later that I could have given aspirin sooner than I did which was en route to hospital but my defence, I was busy and I could have put the seatbelts on before we moved the pt? Again I was busy and it was a terrible tangle with leads and O2 tube and I just wanted to go.

I know that I was excited for the rest of the night but on a deeper level I was also very reflective and humbled by what we had achieved. I could have happily picked up messy vomiting drunks for the rest of the night,,,,, hang on we did! The praise from the ICP was very touching and only added to my feelings of humbleness. I greatly respect that officer and it was said to me quietly the first time and that made it even more important.

So, the Taz will get another photo op in Sirens cause this pt will get a ZOLL watch as well!

This job also makes me realise that I am correct in not going for the level 5 positions just yet, I know that I have been very lucky to have had two saves from witnessed arrests in less than two years. I'm not ready just yet to be the last chance for the pt that rests on the ICP officer.

Here are some scans of the ZOLL print.



The VT!



The Shock!



The return of output!

Be careful out there and I'll see you at the Big One.

Taz

What a great Friday night

Greetings all,
As Tracy commented in the earlier post the broadband has disappeared but I still have the back-up dial-up and I really need to talk about this job.
First some background. The following in an article I wrote about my first cardiac save here in NSW!

By George, we got him back!

The morning of Friday 1st December 2006 saw Paramedic Officer Pete Bouris and AO ‘Taz’ Rundle thinking about the hour or so before the end of their shift at Randwick when the call came in to Co-Ord at 0639 hrs of a 59 y/o male with chest pain.

The officers expedited to the address in Coogee and on arrival were met by the patient’s wife and directed inside the house to George. Initial scene survey showed that the vehicle could be parked in the driveway, but extrication from the house would be very difficult with an in-ground swimming pool taking up approximately 95% of the front yard.

On examination George was seated in a lounge room chair, he was alert, orientated, well perfused but visibly distressed. George stated the onset of a diffuse chest pain the previous evening that he relieved with self-administration of Nurofen. At 0530hrs this morning the pain returned with increased intensity, diaphoresis and radiating posteriorly to his back also superiorly to the right shoulder prompting the CDA to be called.

George’s baseline vitals were, Initial rhythm of Sinus Tachycardia,
Pulse – 100bpm, BP – 170/106, SaO2 – 99% on room air, GCS = 15.
PMHx – Hypertension, Glaucoma, Chest Infections and a problem with his platelets?? Unable to state what exactly!
Medications – Coversyl, Tilade, Nasonex and Lumigan Eye drops.

While vitals were being recorded, oxygen was administered by NRB at 15 lpm and the ZOLL M series defibrillator connected to monitor, it showed signs of possible ST elevation in leads 2 and 3. Because of the George’s unclear platelet problem (he believed his platelet count was low) Aspirin was contraindicated by medical reasons but GTN was commenced and George was transferred to the vehicle.

10 minutes after 1st contact with George and now in the back of the vehicle, the audible rhythm from the Zoll begins to change with multiple VEBs showing on the screen and a rapid decrease in George’s GCS with onset of VT (Torsade de pointes) and hypoxic seizure. A Code 2 was called to activate additional resources to our location while simultaneous insertion of an oral airway and the application of defibrillation pads allowed 1 x 150 joule DC shock delivered at 0659 hrs with the spontaneous return of Sinus Rhythm with VEB’s and a return to GCS = 15.
While George was recovering from the defibrillation our backup was cancelled due to ‘time till arrival’, George’s rapid improvement and the short distance to Prince of Wales Hospital.

A Code 3 was passed en route, urgent transport with George being cannulated with a 16G in the RCF. George was nauseous throughout with vitals on arrival at PoW being,
Alert, Pulse = 60, BP = 145sys, RR = 18 and GCS = 15. George was sitting up and conversing with staff during transfer to the hospital bed and remained stable up until we left.

A magnificent way to finish our shift, a textbook presentation, with all our protocols achieving a positive outcome.

Ps; Six months after the event I finally managed to catch George at home and discuss his case with him. Welcomed into their home again under much more pleasant circumstances George and his wife recounted their recollection of that morning and show me images of the coronary artery blockage that had a stent inserted the next day. Follow-up with his Cardiologist has shown no definable damage sustained to the heart and while George tells me that he has slowed down a little of his busy life, I think he is just more aware of the warning signs.

ps: During the presentation Stephen, Georges son came up to me and simple said 'thank you for giving me my dad back' that makes every bad job for a year blow away.



The article was printed with the picture here, (cut & paste the address).

http://www.thespectator.com.au/pdfs/071116/WSpectator_16-11-07_ALL.pdf


Check out page 7 in this edition of the local rag to see what they used!!!




This photo has been published and I do have George and Stephens approval to use

Be careful out there and I'll see you at the Big One.

Taz

What's new?

Greetings all.
Well the broadband issue seems to have been fixed, we're still on the air anyway.

My new Trainee officer had done a shift swap with a classmate so I've had a different day 1 trainee for each of the last two days. Interesting???? Nothing really good as far as jobs go but we have finished late each day without dining so the penalty rates have been good.

I'm a bit behind with my reading for Uni and don't see any real opportunities over the next few days but I'll have to pull something together before it gets too much.

Shona, our remaining dog seems to have adjusted to the absence of Hope and Tracy and I have too although I did see another Kelpie Cross last week while riding home and I had an instant flash back to when Hope was that young and a brief moment of sadness.

The new hair ribbons seem to be going down well with lots of positive comments.

Thank you to those who have spoken to me about the blog and please feel free to post a comment if you wish. I have left it an open blog so anyone can comment but remember everyone else can read your comments too.

I hope the night shifts bring something interesting but not too taxing for my trainee and as always,

Be careful out there and I'll see you at the Big One.

Taz

Testing, Testing, one,twoo, one,twoo!

We are back on the air.
When we rang up, after checking all of our equipment, the Telstra Help desk dude was trying to tell us that we didn't have Broadband. So there was definitely some major cluster-fuck from their end.
It was interesting to be without easy access, kind of like having an alcohol free day at least once a week????

So did you see that Mark Webber finished another race last night. Well done lad.

Uniforms are all done, I'll drop them at work later and I have a brand new partner for three weeks of this roster before palming them off onto another officer. So I'll have a very active few weeks keeping up.
That'll do for now.

Be careful out there and I'll see you at the Big One.

Taz

In fact they were two cars down.

Luckily one of my colleagues found out about this and contacted management and the call for volunteers was made. Good night we got in on a very messy job and spent half an hour cleaning the IC car.
Still the rostered crews appreciated us coming in. Friday night you need the three crews at our station.

Tracy and I may be off the air as it is for a day or so. Telstra have lost our Broadband connection. Lucky I kept my old dial-up on an annual fee just in case!!!!!

So we'll be back when it's fixed.


Be careful out there and I'll see you at the Big One.

Taz

End of the roster.

Well that's the end of this shift of four. A very constant work load on the first night. Nothing to rubbishy.

The TAO books are selling well at the ACAP shop and I have had another 100 printed up in the new alphabetical format and I guess we'll spend a few hours each day assembling some.

I have also received some very interesting and positive support from superiors and peers. This I have found very gratifiying and has encouraged me to continue as I have started.
I do accept that everyone has the right to their opinion, if you can accept that I have the right to mine!

Ooop! work have just called their a car down in town tonight better go and help with the shield of protection.

Be careful out there and I'll see you at the Big One.

Taz

So what did the second day hold?

Well the quality of yesterdays work was very good and it would have been difficult to expect the similar today, but that's the way it started.
A nasty MVA that had just three of us on it.
A P2, me as a P1 and my level 2 partner worked as an efficient team bringing all our skills into play.
Nothing much really for the pt just ABC.
A scoop and run job, 12 minutes from arrival on scene, package the pt, load an' go, second assessment, obs, code 3 passed, drive as smooth as a baby's bottom through peak hour traffic the 4-5 km to the hospital.

An interesting day if nothing else after this start and we worked hard and long all day without a break, just the way I like it!

Tracy and I aren't going to be parents yet, just to let those who may be interested know.
And I only have one more shift with my current partner, thing are getting swapped around and I'll get a Brand New Shiny TAO, for three weeks till the end of roster.


Enough already,

Be careful out there and I'll see you at the big one.

Taz

What a marvelous day!

Absolutely flew to work this morning on the bike, not puffed at all!
First car out!
Some really interesting work to boot!
Middle aged male, correct interpretation of ECG - ST elevation, correct treatment plan, code 3 passed and he gone to cathlab when we returned with the next one. Good job we made a difference. All that training starting way way back at Rozelle counts for something.
A lovely elderly female who keeps having suspicious falls. Zoll showed disassociation between her pacemaker and the ventricular contraction. Needs a tune-up!

And the absolute screamer of a job, youingish female from a gym. Had just started a weights session ??? 10min with dumbbells when sudden onset of central neck pain radiating to occipital region. One vomit on scene, pain not constant, their ???? possible neck muscle spasms. On the way to the original destination there was just one of those gut feelings about the pts presentation and the lack of success with the analgesia. PEARL, no other neuro deficit but,,,,,, change hospital. Triage put us in the sub-acute area but their examination didn't gel for them so off the CT.


BINGO!!!!!!!!!!

Sub-arachnoid haemorrhage.
Bloody beautiful, the gut was right!
All in all a lovely day.
Good work.
Fun with my partner as we cruised the town.

Tracy and I might have some news on that other matter tomorrow but until then,

Be careful out the and I'll see at the big one!


Taz

An afternoon shift of overtime.

A pleasant shift spent in the South yesterday. I was partnered up with a fellow officer from our station with whom I had never had the opportunity to work, so that was nice.
We shared the work I drove first and later when I wanted to eat he drove (rank doth have its privileges). We got two interesting pts, an older female that described all the classic angina symptoms, Hx multiple Ca's and bloody obvious ST depression. The local hospital here had her thrombolysed within 20 min.

A young male with Wolff Parkinson-White, recently diagnosed. Complaining of ??? chest pain & limb weakness & disorientation & diaphoresis & inability to communicate with friends. Most had resolved by our arrival but the ZOLL showed wide bizarre complexes every 4th or 5th beat so he got a trip and good reception from the staff (they like to get something interesting as much as we do) and then back home to snuggle up with the wife.
How good is that.

Be careful out there and I'll see you at the big one.


Taz

Hopes last resting place.

On the 23rd of last month I posted the sad news that my dog of 15 years Hope, had to be put down very quickly. I was very sad about this as I explained in the post I had only ever lived with my family for that length of time and Hope had been there for many of my life's little and large events. The staff at Struggletown Veterinary Clinic, were Hope has been seen in recent years for her medical emergencies, (Shona found and pulled out to a more open area the rat bait but it was Hope who ate it. That's my dog, always looking for extra food. There was the large haematomma that developed on her right ear that required surgical intervention) have once again proved to me their excellence in not only the care of our loved furry friends but also their emotional care of us the furless ones.
I got the call from them today that Hope had been cremated and her ashes were ready for collection. The call came while I was at the supermarket with Tracy immediately after two calls about overtime. I was loading dog food into the trolley and Tracy had just pointed out to me that we wouldn't need that much. As I finished putting some, most of it back they called! How spooky is that?

Well I have some O/t tomorrow down south and after I had dropped by work to pick up my kit tonight, I stopped in at the Struggletown Vets in Barker street Randwick to pick her up and found myself given this beautiful urn, I was deeply touched and grateful. I had expected just a plastic container. Thank you Struggletown, you may never read this but I believe the look on my face let you know how I felt.


Taz

The last two night shifts.

Greetings all.
First night didn't hold much in fact I was pretty much board and fluffed around cleaning and straightening ready for the SO's return. (Am I allowed to mention that or will the complainers complain????){But I guess that those who know of whom I mentioned,already know them and therefore I can't be invading their - the person I mentioned - privacy by having mentioned them}.

I have already given myself verbal and written authority to reveal that I work in Sydney and as the near absolute majority of the readers seem to be other employees of the government department I work for and therefore already know me and where I work then I am not telling you or anyone else something confidential!
Now there was a big job on last night that has been big news all day so far and I guess that it may have even made it into international news casts [I really can't be bothered for the exercise here to find out, but lets say it did!] so everyone already knows about it. It could be said to be general knowledge then. Well I didn't go to it. I was one of the two ambulances covering the city central area but I just want to say how proud and pleased I was to listen in on the radio as the job ran and the way in which all those concerned conducted themselves and remained calm and focused. From the radio room to the newest ambulance officer there on scene, well done I am so pleased to be part of your team.

Well that will do. If you have waded through this post well done and if you want to read more about privacy and confidentiality you could check out the NSW Health, Patient Matters Manuals, Chapter 9 here

http://www.health.nsw.gov.au/resources/policies/manuals/patient_matters_9.asp

this is a public document that does pertain to the ambulance service and I have read it and I believe I have not disclosed private, confidential or reasonably identifying information about my patients!

I might go and watch that Bondi Rescue now and see myself identified to all of AUSTRALIA as


TAZ the AMBO



ps; I'm getting sick of this, if you don't like it go and look up ASNSW, NSW ambo or just ambulance on facebook and have a ball with that unruly lot!