Got an extra TOIP.

If you don't remember that is a Court based program run by the PCYC called Traffic Offenders Intervention Program.
You get busted by the Police doing something wrong you maybe required to attend this eight week program and listen to me about what it's really like at an accident and what to do along with little thought provoking about how easy it is to change some driving habits and not have an accident.
Other presenter are from the Police, Fire, Rescue, Legal, Insurance.

I was not listed for this one tonight but got called in when the other presenter couldn't attend.

I also piked up the bike from service, new tyres, adjustments to the head set and handle bars, as well as just checking and tightening things. Like your car it is better to get a mechanic you trust to service your daily ride.

The Lance Armstrong Foundation also had received new stock of their cycle wear so I went ahead and bought a set for Tracy and myself,, how cute we'll look like a team when we go out in those!

Not much more done on the job application, I hate writing those things.

I understand that the whole process has to be transparent but when you stop and think about it the selection relies on who can write the best sounding bullshit about themselves.

But that's government job application 101 and that's what I'll try to do.

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

Taz

Something for Australian Ambo's.

OzAmbos

This has been created by a student officer from WA as a forum and information exchange for Aussie Ambo's
It might work, it's up to us if it does or not.
Go and have a look I've already put the cat amongst the pigeons with a topic on education levels.


On the home front,


It's been four months since I had the bike last serviced so I dropped it off today and collect it tomorrow (800km or 500mile) travelled in that time.

I'm also going to try and compose an application for next years ICP intake. It's my first attempt at what is generally accepted as the highest level of paramedic in Australia and does require a few whoops to be jumped through.


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

Taz

Second Night.

First job, Central Station!!!!!

But this pt alerted their situation to the transit staff and therefore we got straight to them.

Young person with abdo pain.
Lower right, radiates to centre, some rebound tenderness, sounds like a possible appendix to me.

Mid Forties fella, eights days post spinal fusion, living rough with back pain.
Gave the most opiate that I have ever given so far and I was only just making a dent in the pain.

I could have given the same again and not maxed out for his weight but I have to walk fast before I run as I become more comfortable with larger drug doses.

And that was it three jobs again,




Until half hour before end of shift.


Respiratory Distress, 60 y/o pt, no asthma diagnosis but has puffers, bronchitis history, HT and morbidly Obese.
Increased work of breathing(WOB), anxiety attack while being wheeled out to the vehicle and worked themselves into such a state that there was a LOC and I had to jump in the back and take over treatment.

There was a reasonable tidal volume,
No wheeze but wide spread creps,
Afebrile,
Initially not cyanosed,
BP?? no idea the cuff (obese) wouldn't fit,
Sinus rythym at 96-98bpm,

I gave,
500mcg Adrenaline IMI,
Two nebs,
MBV or IPPV,
Bat called ahead.

GCS at the lowest of 8 (2,1,5) to unloading of 11 (4,1,6) to full 15 when we left.

No backup called for as we were already en route when the deterioration occurred so Padawan and I just swapped places.

Now that was a job to get the juices going, just at the wrong end of the day, bugger.


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

Taz

First Night.

Twenty minutes searching Central Railway Station for maybe a male with maybe chest pain or maybe not and the ever present Transit Cops know nothing about it!

Found him, on the lowest platform, three tracks underground.

Central heavy pain, slightly clammy, a little SOB, no CABGs or confirmed AMIs.
Oxygen, aspirin, one GTN, two GTN, three GTN no change to the pain.
We've gained the surface by now and are loaded and en route.
ST elevation and maybe some ECG changes.
As I've said before our Defibs are to shock not diagnose.

Can't remember the next pt.
Must have been a stunning job then!

Last pt was a DD (developmentally delayed) pt who was found (after a search again) at Central Station complaining of knee pain. I had seen this person walking without any difficulty while we had been searching.

No ID, obvious lies being told to us and Hospital staff and then I found the phone they had hidden. Found a listing for Mum and rang her.

Pt had had an argument with family and had run away with thirty odd dollars and a soft toy horse.

Mum and Dad were going to drive to the city (two hour trip one way) to pick them up.

And that was it, three jobs for the night.
Yes I was dirty on it. But that's the way it rolls some shifts


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

Taz

Our first trauma together.

Pedal Cyclist.
Pissed.
Wearing helmet? who knows.
Would have been doing Thirty kph easy.
Tried to mount a kerb at this speed.
Has gone over the handle bars and surfed along the footpath on his face!

On our arrival,

He's sitting on the footpath with tissues on his face.
The entire right zygoma region is just one HUGH abrasion.
Five bottom teeth are handed to us, intact so he might be lucky.
A few other little lacerations,

and

The bottom lip is in two separate pieces, all the way down to the bottom of the gum!
And it looks like it has been ripped or worn away not a neat laceration.

Easy enough to treat but it's the first one with this Padawan and it's always interesting to see how they re-act and respond.



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

Taz

Strange Day.

Well first up they sent my Padawan away for several hours to train on a soon to be introduced bit of kit so I got sent to the most well known beach in Sydney to team up with a single officer.
Three jobs, a good post ictal, second only seizure.
The flat stick for the rest of the day (as I like it) ending up doing a shift just short of 14hrs.


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

Taz

In the Burbs again! (sung to Willie Nelson's 'On the road again'!

It's different.
Nobody under Fifty Two years of age.
The chest pain sat on my stretcher for nearly four hours with me popping GTN under their tongue as required.
But I was able,
to use my care and compassion,
to hold a hand and give a squeeze,
to ease the pain and the tension,
to be told time an' again,
thank you, your an angel!

Soppy tripe you may say but I feel good after the work I've done.

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

Taz

What! another o/t shift?

'Well if your really that short of staff!'

So the cold is fast disappearing, we even went for a bike ride today.
When we got home the phone rang and I've got another shift tomorrow at another suburban station not far from the one the other night.

I'll be working with a level one, no problem and after Lance Armstrongs great performance in the tail end of stage 16 I think that I'll buy some Livestrong cycle wear for Tracy and myself.

Apart from riding Trek bikes like Lance we have both been touched by cancer in one of our parents.

So that's what I'll put the extra cash towards.

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

Taz

Still Sick.

Sinus congestion and a sore throat.

ACAP had an education night tonight on trauma, I cancelled my booking for that.

Tomorrow I was due to donate some platelets and plasma but I better cancel that too.

I've managed to infect Ambowife, it wasn't my fault she wont leave me alone???

So plenty of fluids (I like black tea with honey when I'm like this) and rest to put me at the top of my game when my shifts start again.

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

Taz

Pulled an o/t shift.

And on a Sunday, at Sunday rates!!!!!!

Only down side was I would be working in the suburbs, but with someone I know and like.

They tried to sell it up to me but although we did six or seven jobs they were all medical jobs.

Nothing wrong with medical work but why wait till 3.00am to ring if you've been sick for two days?

Anyway good dollars for some easy work.

But some nasty sick person has given me a cold.
Just a cold.
I've looked at my arse, no curly tail there.
Just a sore throat and a blocked nose.
So my days off will be sick.

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

Taz

The only shift I worked on road last week.

Was the second night shift.

Started off with a social services job for an elderly lady whose husband had been in hospital for three weeks and she was now experiencing decreased mobility.

We were four hours at hospital with this job but they are an increasingly common job.

20 something M, assaulted, split lip and a bump on the head, transported.
Mid 20's M, took four ecstasy or MDMA pills but didn't feel as high as he expected??????
Obviously a very bad case of shit pills then!!!!
20 something F, called to a Ketamine OD but was just pissed, gave us a mouthful and buggered off.
Mid 20's M, Intoxicated person who was suffering what would most probably turn into chronic life long porkchopitis.
Called to assist another car with a fitter.
Mid 20's M, stiletto'd on the head in a fight for a cab by the other guys G/F.
The princess who couldn't breath but gave us her life story in five minutes and wouldn't wait twenty minutes for a Doctor, so left to walk back to where we picked her up?????


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

Taz

Dear Anonymous.

Yes that was me on Bondi Rescue.

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

Taz

Recert.

It went fine, just like it did back in January!

We've had some protocol changes so the best part was to sit around with peers and nut them out along with how they might/will alter our actions in the real world on the road.

Skill section was limited and I really only worked on getting better with the Lifepak Defib12 & 15 as these are what will be rolling out. It's really only adjusting to the buttons and going back to an auto prompt mode rather than the full manual with Zoll.


The mental health workshop on the third day was interesting to revisit.
They have more of an authoritative grip on the lesson plan than when I first did it as I was one of the first to complete the program.
While I don't believe it will change any of my on-road practice it will give me more ability to defend my my actions in placing a pt under a section 20 of the Act.

Christopher has arrived today, Tracy is happy. As all mums would understand.


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

Taz

I'm back at school.

Well the ambulance education unit in western Sydney.

When the new Protocols and Pharmacology's became fact on the 1st July so did a new re-certification scheme.

It's a three year certificate with two weeks spent in the classroom, one each eighteen months.

So even though I was only re-certified in January this year I'm back at it again.
Their still getting the bugs out of the scheme and were short of attendees so I received a call asking if I could attend?

It's worth the time to discuss with educators and peers the changes and how we will impliment them in the real world on-road. The third day will be spent revisiting mental health, which while I'm not the best at a diagnosis I do handle this pt very well and with little difficulty usually.

So there won't be anything for a few days but what about Mark Webber in the German Grand Prix,,,,,,, I only got to see the last ten or so laps but well done to the Aussie.



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

Taz

Super Star Trek.

Back when I was only just changed from a boy into a man I went to college (grade 11) and discovered my first computer game modelled after my favourite TV show.

It was played in DOS and if you were quick and managed to get the VDU (visual display unit) or the TV sized monitor that was a black screen with the green text and you printed it on a teleprinter to keep a record of each screen you could enjoy hours of fun.

I've rediscovered it and put it on my computer. Someone has also enjoyed it and was in the IT game and debugged it along with tidying up the code.

It's still in DOS and I have forgotten how to play but I look forward to the challenge.

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

Taz

Got an O/t shift.

It was at a suburban station and we did three jobs for the whole shift and it was some of the hardest money I have ever earnt.

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

Taz

Second night.

50 something F, complete disassociation of ankle and lower leg. Not compound but the skin was the only thing holding the foot on the leg.

45 abouts M, Had a non-qualified friend manipulate his back today and now is doing his best imitation of not being able to walk, this by the way has nothing to do with the way his words are slurrred, how dilated his pupils are or the odour on his breath. A useless transport because I watched him transfer to the hospital bed without remembering to be in pain or incapacitated.

While doing this last job the dispatcher was right on the ball and saw me at the end of the street in which he had a pt who reportedly had been fitting multiple times. As I didn't have a Padawan with me I could respond single so he dropped the job on me.

41F, Unmedicated epileptic, estimated fifth seizure in twenty minutes, oral airway no good - trismus, so a naso then, oxygen, midazolam IMI, I can here the ICP car who are primary response for this job getting closer, BP, BGL, Midaz must be working because the oral will go in now. Their here, handover, assist with extrication get a pat on the back for getting everything done (shucks that's how we do it in the CBD/City) and return to my boring job.

Unable to locate an unknown sex/age overdose who is calling from a room 38 in a motel maybe somewhere in Darlinghurst/Surry Hills. A mobile call so it could be tracked and the CLI owner information wasn't any help.

Flagged down by some EMOs (I think that's right - the effeminate, pouting young men) with an 18F ?OD, no she's just drunk.

Hospital to Hospital transfer of a suspected appendicitis.


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

Taz

Who' watching the Tour?

We ride Trek bikes, just like Lance.

Go Lance.

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

Taz

I broke my new Padawan.

Well he hasn't been at work and I have been getting overtime officers to work with so he must be sick.

He hasn't missed any quantity but there has been some thought provoking jobs.

The 20 something male with facial injuries (minor, post alleged assault) who was discussing absconding when we arrived at hospital, a waste of oxygen.

60 something female who reportedly had a simple fall with a cut to the leg that had stopped bleeding. Turned out to be an obviously fractured ankle, no cut to be seen and the baseline obs indicated an unidentified so far, cardiac issue with rapid AF. Pt denied any SOB, Chest pain or vertigo prior, during or after the fall so I could only treat the fracture.

The AF did get us unloaded straight away though!

A bloody man cold!
Yes he was sick, pulse 104, BP 130/80, RR 20, Temp 40.
Has seen the Dr, is taking the tablets but it's not going away quick enough.
30 something, rang his Mummy first and then us?????????
We took him because that's what he wanted and the hospital sent him home a few hours later.

A 70 something female with reported leg pain and it changing colour.
I've had one of these jobs before and it was a popliteal occlusion, dark blue and very cold so I was ready for that worst case scenario.

Luckily while it was a different shade darker, there was a good and equal pedal pulse. This lady has a current cancer under treatment so these patients always get a trip because as we know it doesn't take much to knock them over.


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

Taz

Theme Works

No, I haven't developed a lisp.

That's just how the jobs felt on the day shifts.

First Day it was Chest Pains - in all the many guises that they can present in.

US tourist, extensive history cardiomyopathy, SOB on exertion, Niddm, No chest pain now but BP 170/100 pulse 80 odd.

From the same Medical Centre,

Female of my age, knows she has hypertension, knows she has bouts of severe hypertension. Declines to take ANY medication. BP 220/110 pulse 54.

Different Medical Centre,

61M sudden onset central, heavy chest pain all the classic features but no history. Minimal relief from posture, oxygen, or the GTN.

All jobs got the full care, attention and drugs they needed.
No-one died in my car.
My new Padawan and I got to know each other.

Day two!

My new Padawan feels confident that he would now be able to diagnose a possible case of appendicitis. because we got two of them as our first two jobs.

A nasty Collies Fracture on a 57F

A quick revision of day 1 on our last job (was he watching me treat those chest pains). 33M, 150kg, history HT & Niddm, rapid onset last 30min of sharp constant chest pain retrosternal. Afebrile, no relief from posture, Oxygen or GTN and I told an ANAPHYLACTIC reaction to opiates. Tachycardic, HT, distresssed, an alarmingly large person from the Iron Bar Motel who while even cuffed still presented a danger if he went off due to the pain.

We bat called it, slipped the lights and noise makers on when needed to push through trafffic and got unloaded straight away.

Long day though, 0700 start, missed our first 30min crib break, got the second from 1642-1712 and then work through 1900 to knock off at 2010


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

Taz

And still more I've read.

Of course the quarterly ACAP magazine 'Response' but I think my favorite has to have been,

'Acute Pain Management, Scientific Evidence, Ed 2, 2005'
Australian and New Zealand College of Anaesthetists and Faculty of Pain Management

All 238 odd pages of it.

Yes I hear you shouting that most of this tome is of no relevance to pre-hospital but how do you decide what is, without going through the lot?

My point exactly!

One point I would like to get some clarification on is they mention the use of Naloxone with Morphine therapy to control the symptoms of nausea and urticaria in sensitive individuals?
Interesting!!!!!!

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

Taz

I've been reading.

Running through the changes to our protocols and pharmacology's I have also discovered a few articles that I hadn't read yet.

'The ABC of community emergency care: 2 The system of assessment and care of the primary survey positive patient.' Wardrope & Mackenzie, EMJ online.

'Protocol Stressing Uninterrupted Compressions can improve survival after out-of-hospital Cardiac Arrest' Busko, heartwire.

'Defibrillation and Cardioversion' Unknown, actually this one is a transcript of a lecture, interesting when you read it the right way.

'Practice Management Guidelines for Pre-Hospital Fluid Resuscitation in the Injuried Patient',
East Practice Parameter Workgroup for Pre-Hospital Fluid Resuscitation,
Cotton,Collier, Khetarpal, et al

Now here is a point that I wouldn't mind getting some feedback from you my readers.

Uninterrupted compressions?
I'm very happy with what I have read and understand the processes, I have seen the ultrasound video showing the flow of blood through the chambers illustrating the five-ten compressions required to get the flow back to what it was before compressions were interrupted.

So why do some clinicians who can put ETs in want me to stop life-saving procedures (compressions) so they can stick a tube down a dead persons throat?

Alright that is a bit harsh but you understand what I'm asking.

Does it really matter how good an airway you have if the hearts not beating?

And yes I also have some 'gun' intubators who can do it on the floor with their legs tucked under the pts bed while compressions continue uninterrupted!

My page awaits your submissions.

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

Taz

And the next night shift was?

Lacking anything that could have been called an interesting job.

Six all told,
Walking pt to Air Ambulance to go home.
Alcoholic seen to be drinking Metho, so? A&E is not the place for them.
Mild Asthma, nothing like last nights, but she didn't have any puffers left so transport was required.
Called to a blocked supra pubic catheter that was ??? blocked, looked alright to us. I mean in my understanding if the yellow stuff can be seen going from the body to the bag it's not blocked.
The N/H staff wanted it checked so we had to transport and then returned the pt without unloading.

Midnight saw the introduction of our new protocols and we were able to assist someone to bed with less paperwork and to give someone else who was suffering a normal flu some panadol.

Jumped on my bike today, second day off and rode over to Divisional HQ to drop off my application for the higher duties job.

A difficult position to fill. There is no external applications to contend with as you have to be an operational officer already but their looking for management qualifications???
I'm a Paramedic, not a manager but that's their problem. It was good experience to write the application and if I get an interview well it's up to me to sell what I can do.


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

Taz

What do you think of the blinky?

That's what the new artwork by Ambowife is called.

I guess the nights were midweek so the quantity wasn't there.

First shift had only six jobs,
Air Ambulance to hospital,
Intoxicated and needs to sleep it off,
Homeless, ejected from a hostel tonight, now ringing us up for his chronic conditions.

Two that did interest us were,

Asthma, severe unwitnessed episode.
Known asthmatic with nut allergy,
Very tight chest but moving air?
Unresponsive to Salbutamol, Atrovent and Adrenaline.
No or little communication either verbal or non verbal best GCS = E4, V1, M5.
Mottling on abdo that disappeared after the adrenaline.
Code 3 to the hospital.
They were as confused as I was.
Pt got more nebs and adrenaline, again without effect.
Sedated and tubed with diagnosis ?Asthma in Extremism.

Abdo Pain (not a job that you usually get excited about).
Post Op, about two weeks, from an emergency appendectomy,
Sudden onset over afternoon.
Nausea but no vomiting.
Rigors (chills).
Vertigo (BPs 104/60, HR 130, RR 32 & febrile)
Maxalon 10mg IVI,
Morphine 7.5mg IVI (9.5 pain down to 5)
Fluids 300ml

A sick person that I could make a difference to and as always was apologising for calling and would have made her own way to hospital if she could have gotten out of the door.

Oh, and I didn't win anything on the $90mil Lotto draw so there goes my own personalised ambulance.

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

Taz