The punters are trying to behave.

In the lead up to NYE and all the celebrations that it will bring and with the school holidays there are a lot of people out of the city and there has really only been mundane work.

28M - Pedal cyclist, face planted over the handlebars. Not wearing a helmet, got a lecture from me and informed that it was a $120.00 fine if he'd been caught by Police. Looks like he has busted his nose but elected to go and see his LMO.

38M - Very localised right sided abdo pain. Family history of kidney stone and still has his appendix. Imaging and more tests needed to complete a diagnosis.

82M - A rigid, swollen and contused right calf. His is on wafarin and the pedal pulse on both feet was damn near impossible to find but they were both 2-3 second cap refill. I thought he had heamorrhaged ino the muscle. The triage and Drs liked that idea and kept he there.

73F - Near syncope inside a church. It wasn't stuffy, well ventilated and if anything cool but she took a very long time to appear anything like normal so we convinced her to come to hospital to get checked out and I have a suspicion that it was mostly behavioural she was just sounding a nervous Nellie.

39M - Bad sciatica. He's had it before. He had the usual medications at home to manage but it wasn't to be. I get sciatic pain when I over do it and I understand skeletal pain well from my many hip surgeries, he was struggling with the pain so we started him on some fentanyl (synthetic Morphine X80 stronger). Chronic pain sufferers wear fentanyl trans dermal patches that may deliver a 25mcg/hr dose. We deliver it intranasally like one of those decongestant sprays. 240mcg didn't make must difference, checking obs and observing the pt he took 540mcg to properly control the pain and he wasn't hypotensive or with a decreased resp rate he was bright and sharp and pain free. I don't like pain.

?30M - Addiction is hard to kick and many services are available but few succeed first time. This pt had managed to complete rehab and make it to the share house that assists to integrate the pts back into the real world where so many addicts fall back into the same ol' routine. Our pt had failed to resist and paid the ultimate price.

48M - Very minor injuries post a MVA, he just wanted them documented. Left with Police after treatment.

84M - Lives in a hostel/nursing home, is ambulant without any walking frames or sticks, had a fall four months ago was assessed in the ED and treated, had a fall last week but suffered no injuries. His LMO has put him on a diuretic (increases urine o/p and decreases blood volume and BP), increased his opiate patches (that may dialate blood vessels and decrease BP) has a 2 day old blood test showing his Hb to be 100 which is high for him with a known Hx of anaemia.
LMO thinks he needs to be assessed but for what, why can't his own qualified LMO do it rather than bumming him off to an over taxed ED? Where is the emergency with this pt?


As of yesterday we have managed to reduce our road death toll from last year by a significant number of 451 to 419, well done NSW motorists.

See you at the big One.

Taz

What should you not do on a glass top coffee table?

29F - first pt, the answer is sit on it! It shattered, she got a few cuts that needed some stitches.

49M - First cardiac arrest we're called to for the day, ??? seizure in a methadone clinic.

77M - At rehab post mitral valve repair and has sudden onset of tachycardia not resolving.

52F - Pillion passenger on a motor scooter. Wearing Bondi Safety Shoes (thongs or flip flops). Driver gets too close to a curb and her toe nearly gets ripped off. Stupid.

91F - Abdo pain, has confirmed gall stones, transport for management.

51F - Second cardiac arrest we're called to, opiate OD. Claims that she thought it was cocaine. Narcan, refuse transport left in care of a friend.

That was my day.


See you at the big One.

Taz

What does EMU stand for?

Well in most of the hospitals I attend it's Emergency Medical Unit.
Having said that there rarely seems to be anything of an emergency nature going on in there.

By in large they are waiting areas.

Waiting to go up stairs to a ward from the ED.
Waiting to be collected by family or us for transport home or further care.
Waiting for discharge from the unit back into society.

All the big hospitals have them.

I found this at the little inner city hospital that we usually take the abdo pains and drunks to the other day.

Officially none of the staff knew of it's existence!


Look at it, I know there have been cuts in the budget for hospitals but no mattress!
Just one blanket!


I'm not sure that OH&S would be happy with a glass bottle and the neck is terribly narrow to take a whizz in anyway!


And that dear reader is my silly post for the silly season.

See you at the big One.

Taz

Twas my last shift before Christmas!

2M - Has hurt his arm at day care. Mum has arrived and can't console him, his guarding the limb but of course with a young one there is seldom a fully visible deformity. A quick whiff of the Fentanyl and away we go for an x-ray.

29M - Suicidal thoughts. Not uncommon this time of year. Not known to us and was judged as a significant risk so almost straight into the psych ward.

23F - Lower abdo pain. The Methoxy whistle and transport.

61M - From the Air Ambulance base to hospital with triple vessel disease.

18F - Claiming haematemisis after Goon (cheap cask wine where they remove the bladder and drink out of it!) and a few puffs on a joint!

And that's it.
Christmas day with my beautiful wife and just relax with our 2011 protocol and pharmacology updates and some other clinical improvements that will bring all of the health services to the same point.

Have a good Christmas if it's your thing.
I feel it's just another day and do get a little pissed of with the seasonal festive goodwill to people when it should be all year.

Don't even get me started on the commercialisation!!!!!!!!!


See you at the big One.

Taz

Reader Comment.

I got this on the post about total numer seen and the number of patients per shift.

Anonymous has left a new comment on your post "And the total has been reached!":

Hi. I'm enjoying the read. Of those 1104 patients in 144 shifts, how many were transports to hospital, how many were non-urgent transports somewhere else (drop patient off at nursing home, etc.) and how many did you turn up and not need to transport the patient?

I don't know.

The post usually indicates if it was say a discharge to N/H or hospital to hospital transfer.

As one of the pioneer officers in the Clinical Assessment & Referral (CARe) program that was introduced in ASNSW several years ago and is of 2011 to be included into standard clinical training, on many jobs I was looking for possible other options than presentation at an ED.

Thanks for the comment and reading my little world.


See you at the big One.

Taz

Twas the first night before Christmas.

Well it was my first night shift before anyway.

31F - Relationship issues and maybe while washing a glass it slipped and cut her wrist, up the arm not across. Transport for stitches or gluing and maybe a chat.

46F - Been seen today for same at hospital, there is some diarrhoea but after I relieve pain they decide to hold off until tomorrow rather than wait in the waiting room. I had given her a whiff of Fentanyl, it was twenty five minutes before I left and it's only effect on her was to take the edge of her pain.

18F - IP, seven schooners of cider and beer mixed that are called snake bites! They're worried that her drinks been spiked,
Ya THINK!!!!
Which bit the excessive cider or the excessive beer!!!!
Transport her her safety.

40F - Anxiety, not doing well out in the world after rehab,
We talked and I seemed to calm down her anxiety and she decided to wait and go see the councillors in the day time.

71M - Unresolved vertigo this AM. Significant recent cardiac Hx AVR (aortic valve replacement) and one CABg (bypass). BP's good, no postural drops, no inner ear issues, strong pulse but it's funny irregular. Put the lifpak on and there we have sinus tach with 'P' waves and now we have Bi-Geminy for ,,,eight seconds and this was all at rest supine on the bed.
Got ya', the plumbings good it's the electrics on the motor.
Transport of course.

See you at the big One.

Taz

What a difference a day makes.

With our sparkling clean ambulance we attended the following,

81F - Regular dialysis pt who was royaly pissed because we were really late picking her up.

30M - Chest wall pain. Has had it for six hours, no cause like trauma, over exersice. Equal air entry no deformity, we were told by hospital later that there was nothing found and he woke up pain free from the analgesia and was discharged.

Pain is a very subjective thing and many times we are made to shake our heads at the reaction some pts have to their perceived 10/10 pain.

24F - Asthma not relieved by her own meds. We were the second car to arrive so I didn't get a peak expiratory flow rate before our bronchodilators but after two nebs with 100% O2 it was at best 305 l/min with her known max of 550. She was fair pinging from the amount of salbutamol (ventolin) that she had taken.

97F - Still lives at home alone with meals on wheels and home services coming every second day. Today she had finally rung her Dr about a cough she had and he had rung us. She was hot enough to cook on and just to hear her breath in the same room as you was like listening to a gravel truck go by. Transported.

49F - Abdo pain. Have any of you noticed that the are some wealth people are just dumb about their own health and what is it like to be really ill. There was by her statement a stomach twinge and she thought she was going to die. She eventually left in her own car to do some shopping before going to see her LMO.

70M - Mechanical stumble, a bit of skin missing but just requested assistance to his front door.

MVA - three cars one with a pt trapped by confinement (the door wouldn't open), the Water Fairies got it opened as we arrived and we got cancelled.

55F - Well known to most city ambo's and ED's, developmentally delayed/ brain injury, lives in a group home and when she has a fight with someone she gets on a train and comes into the city and gets people to call for an ambulance. Most usual presentation is claiming to have had a seizure or to feel that she's about to have one.
Today we picked her up from a railway station. Took her to the little hospital in the city. She left after the Dr sat down with her and explained again that we all know her real Hx and that there is nothing wrong with her.

55F - Sitting in a hair dressing salon, yep! same pt and because of our system if she asks for transport I have to take her. To a different hospital where the social workers aren't the nurses and can spend time to sort her out.

13F - who is developing multiple food allergies and felt some of the symptoms, maybe. Was with mum who told us that there was a likelyhood that some anxiety had developed and multiplied the sensations. No airway involvement and when she had calmed and thing resolved mum and dad took her home.


See you at the big One.

Taz

How many ambulances can you wash on a slow day?

After going out early for night shift to a,

??M - was walking, is now lying, he maybe dead! How the hell did the call taker allow the caller to make that leap? Unable to locate.

All the day shift crews went to the waters edge for coffee and some idle chat.
Then we went back to station and waited. No jobs came.
So we got the washing gear and tubbed all five of our vehicles.
And then it started,

7M - Had a tummy ache and got mum to ring the ambulance. Mum was given directions to manage him and he stayed at home.

33M - With Police who were concerned for his altered state. He was under the effect of drugs. His friends were reasonably straight (un-effected) and took him home. Good result.

24M - Psych Hx from interstate, was seen yesterday twice. Personality disorder who loves the attention.

47M - Abdo pain but very asymptomatic.

54F - who fell and did a good job on her chin. Transport and she left within the hour sown up.

27F - Syncope, 8 weeks pregnant, there looked to be partial seizure activity Drs need to sort this one out.

55M - on a scooter and got clipped by a car. Transport for x-rays to cover any later insurance issues.

See you at the big One.

Taz

Social commentary. Maybe not interesting.

Kept my ambulance running.

It doesn't mean that we were any better at our jobs than other crews.
We had some luck with the type of job, the circumstance/setting of the pt, location.

The old 'You call, We haul' is indeed the safest option in the view of many still in the current ambulance service.

Your taking every single patient to the hospital to see a doctor.

This is safest mainly for your benefit, it covers your arse.
You care,
Cover Arse, Retain Employment!

It is best for the pt?
Is it best for the health service (hospital)?
Is it best for ambulance services?

No.

We have to think outside the box, be proactive not reactive.

It wasn't hard to see that the asthma pt had a home nebuliser and think what if we left her a few ampoule's to use over night rather than unnecessary transport to hospital.

The all over ache's for over a year, to the low acuity little hospital to be put in the waiting room, and while there are not drunk tanks as such unfortunately that's what we use the waiting room for. If they can sit or have someone to keep them sitting they can also leave when they're sober or less drunk.

It's not transporting everything because it's easier for you.
It's not leaving them at home unsafe.

It's clinical decision making, it's taking your professionalism further and even educating the public not denigrating them.

I'll get off the soapbox now.

Besides, the fact that you're here reading this means that you do already have these qualities.
Your the right stuff in a sometimes bad place that we love/hate to work in.


See you at the big One.

Taz

We kept our ambulance running all night.

More by good luck than planning. A whole heap were stuck at a few hospitals with no unload times.

34M - IP near the big train station, taken to the little hospital in the city that deals with this type of pt so well.

55M - In the road behind the same little hospital, maybe drunk or maybe dead. Gee that's useful job details, UTL, a witness stated that somebody walked a drunk into the hospital???

24M - Known to me with Hx's of ETOH abuse and self harm. He had slashed his wrist upwards not across. No arterial blood but a good strong ooze.

86F - Febrile with a savage cough.

39F - SOB. Had run out of nebs for her own machine. Some quick obs and a peak expiratory flow test and leave her a couple of ours for later if needed. Left at home safe with meds.

49F - All over body aches > 1 year. To the little sity hospital again. They love this type of pt.

40M - IP and not responsive to any of my pain. Very diaphoretic, just a little hypotensive. He didn't flinch with a 14g in the cube, some antiemetics and fluids and low and behold who starts to come around at the hospital with it's own TV show. Still maggoted but with eyes open now.

37M - Near drowning, boat owners had thought the shouting was coming from another boat for about ten minutes before they went out to check in the marina. The dude's still in the water struggling. He was dragged out by the time we arrived. Hypothermic, confused, urgent transport.

See you at the big One.

Taz

OMG what a boring night.

10M - Fell off his skateboard onto his arse. Somebody with a mobile called for an ambulance, for a sore arse. Pt went off with his mum to watch the fireworks after we had diagnosed a sore arse.

37F - Epigastric pain. Really very distressed. Transport to investigate.

14F - IP, transport for safety and to wait to call Mum. Manditory reporting to Social Services.

38M - Now it could have been the booze or the thrashing he got from the bouncers that had him in an altered state. Fifteen minutes after unloading when he refused to use the bottle and bounced out of bed and walked to the toilet,,,,, I guess it was just the booze.

And that was it for the shift.

See you at the big One.

Taz

Opps, sucked into the suburbs!

A beautiful day, Oprah is in town and it's getting busy.
We are stuck in the same area south of the city going back to the same already full hospital.

42M - In Police custody and has a headache, here are two panadol.

72F - We're really not sure what happened, a language barrier, but it appears she fell to her knee and the pain was that bad she got the family to call and ambulance. No laceration, contusion, mark or deformity.

78F - Vertigo and leg weakness. She thought it was a CVA but it was bilateral. Transport for more tests.

75F - # NOF. Just fell from standing.

85F - PR bleed.

89M - Febrile, lethargic, infection but where? Tests will located and treat.

See you at the big One.

Taz

You can have a day full of nice patients.

52F - stumbled on the bus and struck her nose on a hand rail. There was a small lac and the bleeding had stopped but asked to see her photo ID and that thing as way off to the side. When she asked what an ED would do I was honest and said just take the x-ray and refer her to a specialist, She said well my LMO can do that and we agreed. Left to see her own Dr.

77F - A pt known to me or rather the wife of a pt. He has recently had to be admitted to full time care and she really isn't coping with the guilt feelings. This has lead to depression, anxiety and are manifesting as physical symptoms with no pathology. We transported to seek some professional directed care and assistance.

44F - Just on a quick connection layover at the airport and BAM, the abdo pain that has been slowly growing since they departed jumps to a 9/10 and she nearly faints. Good country stock, not prone to over doing illness and with no Hx I'm stumped. All her innards are in fine working order and she's already had the gall bladder out? Transport for tests, and re-schedule the flight.

89F - Had a fall two weeks ago interstate. Nothing found on the ED discharge letter and sent home with analgesia to self manage. The pain is not responding to the meds and has not shown signs speedy enough for her liking for recovery. Wants to go to our hospital to get re-examined.

29M - Fell over last night a bit drunk with his arm under his ribs. This morning it feels like he may have broken a rib or two. X-RAY!

Assist another car with a difficult extraction of a suspected spinal pt.

30F - 33/40 gestation and having a small haemorrhage but can't located from where PR or PV. Not really something we go looking at and with the advanced pregnancy transport is the best.

89M - Helping his son to move a filing cabinet and it dropped on his lower leg. Nasty big laceration nearly 3/4 the length of his shin and down to the bone.

See you at the big One.

Taz

Hello RKR!

This is in response to his comment on the post Much more transport tonight.

Greetings to you too Dude.

VACIS or eMR as we are calling it, has I think now completed it's trial period at selected stations and will begin it's slow roll out here in 2011. I'm sure I have read a time scale for it's implementation but as any of us know these things usually take longer than expected.

I remember in my previous life when computers where going to give us a paperless office system that manual invoicing (which is really what part of the documentation is for) was decreased by 95% but the books were never thrown out.

There are really only four levels of officer in our service,

Trainee - your induction and basic training at school (8 weeks) and the remainder of a year (usually) on-road with Qualified Officer mentors.

Paramedic Intern - after another stint at school and then anything up to two years on-road for skills consolidation and development. There are many things in this job that can't be learnt from a book.

Qualified Paramedic - another stint at school for the largest jump in skills and knowledge.

Intensive Care Paramedic - not a natural progression for all who wish to gain the extra skills, knowledge and responsibility but a hotly contested, merit based selection system with limited positions. It does, and this is my opinion (like arseholes I'm allowed to have one before any ICPs try to rip me another), it deters really good officers who are not the cream of the crop at examinations, interviews or application writing.

Then there are the speciality positions, Rescue or Special Operations Team, Flight Nurse or Paramedic, Rapid Responders cycles and cars.

The eMR is going to have all the protocol and pharmacology on it but you'll always need a book on the job.

And as a note to any reader you can always drop me a line direct to taztheambo@gmail.com


See you at the big One.

Taz

Much more transport tonight.

73F - Fall, stumble, tripped through a fly screen. ? a fractured shoulder. Analgesia and transport.
21F - Pancreatitis, confirmed diagnosis recently. Analgesia and transport.
90F - Discharge to a rehab with fractured humerus.
26F - IP, with her husband who was fine. Some busy body passers-by had called in and waited to tell us that she needed to go to hospital because she was intoxicated. Husband just wanted to go home, friends had a car and a nominated sober driver but busy body had passively stopped them from leaving until we had arrived. We released them and smiled insincerely as busy body walked away thinking they were important.
50M - O/s tourist with a fever. Been in the country for over a week so I guess they've caught one of our bugs. It was 40 degrees so transport was indicated.
Major incident; on the harbour.
20M - C/o mid thoracic central back pain. Collar, spine board, transport.
36M - Shoulder blade pain from fall suffered in same incident.

Back to normal-ish patients.
I don't care what colour you are, sex, age, race or religion but there are some who draw attention to their group and reinforce stereo types, such as FAS or OMG.

32M - IP, interestingly they are of a religious background (they informed me) that I know doesn't drink. There are not only language barriers but cultural differences. Wailing and gnashing of teeth while head butting the inside of the car or bashing the arm that is supposed to be injured does not go down well with us or the hospital. I tried to explain that ambo's, nurses and Dr's should not have to defend themselves from pts who were physical. Security kicked them out because apart from him being a total wanker there was nothing medically wrong.
35M - Deep lac to the muscle at the base of the thumb. needs lots of stitches.
53M - Heavy chest pain. Protocol and transport.
37M - Abdo pain, sounds like renal colic ,,,,,, interesting that that was the last job on the previous shift also.



See you at the big One.

Taz

Who will come, in my beautiful ambulance.

88M - Not feeling strong but doesn't want to see a Dr. Left at Home.
20F - Drunk and assaulted another innocent female. Left with Police.
20F - Running about in traffic, It was a call about the girl we had just seen but took longer to filter through from the call taker. Still had to do paper work.
55M - SOB, how about a blocked nose, honest a blocked nose. 'No I don't think you need to go to hospital sir'!
45F - IP at the big train station, who had got on a train and left when we arrived.
43M - Minor facial wound post assault. Declined transport and left with Police.
??M - Unable to get up. The location was the other side of the shops we are at with the last job,,,,,,, Duplicate call I reckon, we couldn't find anything.
24F - IP, I'm not sure why we got called. Pt was standing by herself, talking and drunk. B/f was on his way to collect her, left with her friends to wait for him.
BRAWL - multiple pts. Yeah right. UTL.

At this stage of the shift we have not transported a single pt. I'm starting to get desperate for hospital coffee!!!!

39F - IP, Xmas party, has never felt like this before, this drunk that is. A lovely lady who was in need of our help. Her friends had been trying to get her into a car but the evil wobbly leg syndrome kept stopping her.
21M - Xmas party IP, had fallen on his wrist but against a gutter and given himself this huge skin tear come laceration. Definitely needs hospital.
80M - Decreased mobility. Which is a known issue and there is an underlying dementia but he doesn't want to go. We've all seen the battle between that aged couple who really needs to have one in care because the other can't physically care for them any more. Left at home to see if the family can help to resolve.
34M - Abdo Pain. Renal colic.

See you at the big One.

Taz

Can you give cement to a Pt?

Only just enough so they could toughen the Fu*k up, like this guy.

30M - Had got off the bus outside work, was talking to another employee, finished, turned to walk into work and walked into a street sign pole. Not ran, not tripped and fell but walked and hit his head.
Rang for an ambulance because his head hurt, there was no visible injury, there was no swelling, there was bleeding, there was no mark at all. There was no motor/sensory deficit apart from the moment he had hit the pole and it 'went dark and I could see stars and my legs were like jelly'. He had taken no analgesia and had only called his mummy who was a Dr who thought he should go to hospital.
I'm aware of the worst case scenario and complications but he hadn't even tried an icepak and some simple analgesia, no called for an ambulance and talked it up so hit was a hot response more lives at risk because he's a soft co*k.

40M - Poly-pharmacy OD. Anti-hypertensive and herbal sleeping tablets.

21F - Period pain, nearly bad enough to make her nearly faint, or so she told us after we arrived to find her sitting in reception waiting for us. (MORE CEMENT NEEDED). It was given a hot response for a pt who decided that 'Oh no I don't want to go to hospital'.

52M - Know street dweller seen to have what sounded like a good description of a seizure on a park bench.

39F - Chest pain from a Dr's clinic. I think it was more to rule out cardiac issues or ischaemia really.

32F - Hypoglycaemia, it took a good while to bring her back and she was at work so I was keen to transport.

9/12mth M - had a chomp on a brittle plastic Christmas tree ornament and freaked the shit out of mum. The was a minute amount of blood in a little drop of saliva from where he had spat it out. We transported and explored the back of the vehicle.

See you at the big One.

Taz

4th Anniversary of my first Cardiac Arrest save.

Yep, four years ago I can claim my first witnessed and saved cardiac arrest.
So with that in mind and with a student from our education as a ride-a-long we set out on adventure today.

It didn't seem to be happening though!

32F - Near faint in the underground train station or maybe it was just Floppy As*&^ Syndrome that I have blogged about before.

63M - Who was vigorously scratching his male member and made it bleed. It bled quiet a lot despite bandaging. Honest readers you couldn't make some of this sh*t up.

93M - Nursing home staff say his GCS has declined this morning. While none were on his meds chart I think he was doped out of it.

50F - A simple mechanical fall going to her birthday celebration. A face plant but during examination her central mid-neck was very tender. No motor/sensory deficit but all precautions taken.

64M - Post ictal. Was by himself so I had to encourage transport and he did eventually agree.

49M - Chest pain, yea sure, we eventually locate him because he doesn't really know his exact location. Doesn't look the best, short history AMI two months ago with two stents and today was his second day back at work and he was just driving when the pain came on.
Three leads show elevation in 3 & AVF so while I'm technically not supposed to be able to understand a twelve lead I do one and confirm a STEMI and treat with O2, Aspirin and nitrates we were too close for me to get any morphine for pain just an 18G in the forearm.
Pass a code 3 to the hospital, walk in with all my prints and up to the cath lab we go.
Funny it happened today.

Thanks to PP Author for the comment about anonymous comments, that's how I handled it in the end.

See you at the big One.

Taz