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29 December 2011

I did a lot of driving today.

And we attended a lot of cases.

62M - Pre booked transport for a medical appointment.
79M - Pre booked transport for a medical appointment.
75M - Was having a minor procedure needing sedation and had a slight regurgitation that was suctioned. The attending health professional refused to proceed until the pt's chest was x-rayed to clear from aspiration fearing pneumonia. The pt was completely asymptomatic, normally health, active, without any respiratory Hx and able to cough deeply if asked to. The look from the attending at hospital when I was asked for the five word triage was readable by even the pt when he demanded of us 'Well what am I doing here then?' and we simultaneously replied 'We don't know!'
75M - Emphysema and increasing heart failure leading to increasing SOB.
??M - Was assaulted in a Welfare Office but wanted nothing to do with us. SNR
53M - Very irregular AF hospital to hospital transfer.
64M - In a Dr's rooms presenting with chest pain, found with an O2 mask on and the residue of an aspirin on his lips. No notes, handover shouted from half way down the corridor by the Dr, finished with I'm to busy without my nurse can you handle him or something similar. Yes we can Doc and I left a copy of my 12 lead clearly showing the pt having a confirmed STEMI and he was in the Cath Lab about 20 minutes later.
42M - In custody of the constabulary claiming to have swallowed a plastic bag containing 20+ Oxycontin tablets (he was selling them). The qty had dropped by the time we arrived and he was asymptomatic advise to the Police check his Poo if you want because they should travel the length of his GI in the bag or call us back if he changes.
50F - Pseudo fitting.
67M - IP who was very nearly home so we helped him.
52M - Well known street IP removed from central city shopping mall to a suitable small hospital to sober a little.

Now a discussion, what would I have done on the third job.
Lets think of these few thing.
The patient had been nil by mouth apart from a mouthful of water for his BP meds this morning.
That was all that seemed to have come up. It was suctioned, he was sedated not unconscious so therefore had a gag reflex.
The procedure time of maybe an hour was now increased by the transport to a hospital.
Examination time because that's the hospital doing their job properly.
X-ray if they thought it necessary, they didn't (wiser heads and common sense).
Write a clearance letter and return of pt to original location.
Even then the hospital would advise the pt that if he felt any adverse effects from the regurgitation to call for an ambulance or attend his Dr or a hospital.

I believe that the procedure could have proceeded and this same advise be given to the pt and his carer after his recovery time and before discharge.

Is that unreasonable? 



See you at the big One.

Taz

27 December 2011

I did a lot of talking today.

 Even for me!

61F - Hypersensitivity to penicillin for the first time. Itching and redness no airway involvement, antihistamines worked a treat.
51M - Angry, depressed, feeling violent towards specific persons and hopeless. I sit and listen occasionally adding a brief comment. Build the trust, mark boundaries and treat him like a human. He wasn't admitted, he wasn't committed he talked to the mental health team and when he left I was there on another case and he brought them over to me to thank me for giving him hope in them to help. No drugs, no machines or gadgets just humanity.
22F - Jay walking and got clipped by a truck. Minor injuries from the road surface.
34M - Truck driver, emotionally devastated from seeing the careless pedestrians head disappear beneath the front of the truck. I spent more time with him just quietly talking.
73M - Local alcoholic who calls when he's tanked.
71M - Nausea and vomiting for greater than 12hrs without diarrhoea.   

See you at the big One.

Taz

25 December 2011

A very Sad start to Christmas.

This is not a post about the nature of our work.
It is a reflection for one of our own who has given his life to try and save anothers.
The world of Pre -Hospital Care, Paramedicine, EMT or what ever your local term is has lost a member in active service to his community.

Australian Paramedics Mourn

To his family and his colleagues my deepest sympathy.

Taz the Ambo

22 December 2011

T'was the last shift before Xmas.

And not much good work was stirring.

46M - IP in a Mall.
60F - Mechanical fall against a door knob and wanted our assessment. Left at home.
68F - Non cardiac chest pain, left at home to see LMO tomorrow.
43F - Very nice IP that was ashamed to need our help when she ran foul of the Christmas drinks.
19F - Floppy attention seeking pt. Wanted to go to hospital for ?? sympathy but when her posse' told her to stop being a 'rabbit' (my word not hers ) pt's symptoms instantly resolved and she got off the stretcher and left the vehicle.
31M - In a shelter, staff concerned about pt hearing voices.
18M - IP backpacker with a small face lac.
19F - Hospital to Hospital.

Be good and be safe where ever you are.
Let peace and goodwill spread to every day and stop after seconds.

Lots of love and eternal best wishes from Taz the AMBO.

Sent away again.

The same station as the last shift but a different partner.

31M - What I believe to be a drug affected person who needed to be observed while they came down before talking to Police about a very complicated issue that they were the victim in.
40M - Lumbar back pain after a fall that he had been trying to manage for two days and as tourist that can be rather hard and earned brownie points with me.
??M - Requested an ambulance when he felt claustrophobic in the Police cells (Dah) but recovered very well when given bail. He also managed to push a button with me by ask/demanding why we had taken so long and I shot back a 'We don't rush if your not dying!' Should have really just ignored him.
30F - Absconded from another hospital with psych issues, found by Police 100km away and conveyed to another hospital by us.
??F - Alleged stabbed in neck. Little cut on check. Pt left with another crew already on scene.
75M - Dislocated artificial hip. With a difference while the house was only single story the bedroom was right next to the front door! Nice wide hallways in which to manoeuvre the pt supine on the scope stretcher might have made the job even easier. 20mg of Morphine and some neighbours to help and we got him out.

My last shift before Christmas tomorrow so hope I get to work with my assigned partner just for something different.



See you at the big One. Taz

20 December 2011

Follow up on the last post.

I've just gotten up from sleeping before my night shift and see our last job from yesterday in the news.
The pt was attempting to perform some stunt on the balcony (it wasn't planking) so the reported states, and slipped in the rain.
Approx 25m fall and as I said the wet ground saved him, injuries reported to the media were # pelvis and ruptured spleen. No spinal or brain injuries.
A very lucky man whom I'm sure will seriously reassess risk taking behaviour for the rest of his life now.This story also illustrates the care that should be taken by everyone as you rarely fully know or appreciate the consequences of your actions until it's too late!

Your Mum was right!

'It's all games until someone losses an eye'

See you at the big One.

Taz

19 December 2011

Working with someone different again!

Minimum Clinical Level on a ambulance vehicles is one officer to be fully qualified, or that's the desired level.
In many rural centres with limited =numbers of staff it may not be possible but in the city when two qualified officers are teamed up they can expect to be spilt and sent away to work with level 1's and 2's at other locations. Such a situation happened today and I went away.

92M - From home to a palliative care ward at a distant hospital. Dorothy and Toto were  not in Kansas.
92M - Acopic, lives with his slightly younger sister but it looks like he'll need higher level care.
41F - Fell on wet concrete and hurt her shoulder.
18mthM - Had a single vomit. Mum freaked but had calmed down by the arrival of the single responder and we were SNR when we arrived.
89M - Had three falls today, feels weak, is septic!
??M - supposed to have texted the neighbour about being depressed. Not as stated, SNR.
69F - From home to palliative care.
?30M - Jumped/Fell/Tried to fly! Whatever the cause this pt started 25m higher than where I found him. Soft rain soaked lawn saved him. No visible #'s but suspected pelvis at the very least and spinal, Unpalpable BP, tachycardic at the very least from the cocaine the friends stated, GCS = 3 but increasing en route to agitated. Abdo firm to hard, upper left chest ?# of ribs and clavicle.

So a hell of a well run and executed job to finish off the shift.

See you at the big One.

Taz

18 December 2011

First shift with another new partner.

We worked once when she was a probationer at a special event but that was nearly 3-1/2 years ago now and she's a fully qualified officer.

51M - Back pain on an old injury after helping the removalists with the boxes.
86M - SOB chest infection.
67M - IP got in a scuffle, went to police we found no injury other than pride.
17F - Near syncope at work they panicked. She went home to rest.
25F - Hyperventilating.
70M - Lethargy tachycardic even on beta blockers.
25F - 5 minute witnessed by me seizure. No epilepsy Hx.



See you at the big One. Taz

15 December 2011

Not a popular night for a party.

So the last night with my short lived current partner was likely to be quiet.
Due to a short age of staff and the requirement to place qualified officers with all unqualified we got split and I worked with a level 2 from somewhere else.

75M/F - Unwell, the pt was an ol' showgirl dancer from the 'Le Grils era.
31F - A little drowsy but safe at her responsible Mum's place. Left there.
42M - Rib pain from several days ago, currently in a Police cell and was less than polite with us, we left.
49M - OD on some heavy duty bad arse barbiturates Neuramyl or Amylobarbitone.
40M - IP who we finally managed to get home only to find he had no keys. He did have a phone and had the inglorious pleasure of Police and Ambulance dropping off at his Mum's at 0500hrs.
47M - Opiate OD, Tx for observation after successful reversal. 

See you at the big One. Taz

13 December 2011

Start the shift in a Police Cell.

First job that is, was from the cells, that's the only time I've ever been in Police cells. Apart from a speeding fine 30 years ago, a Police parking ticket the same year and being caught exceeding 0.05 blood alcohol  while driving 11 years ago (my personal epiphany moment) I'm unknown to the Police.

35M - Is free to leave the cells in fact but requests an ambulance, claims a 2 day Hx of being unwell and that he was on his way to his LMO when the Police arrested him.With his Court appearance papers and what articles they would release to him we took him to a hospital. The nearest hospital, not the one nearest to where he lived.
51M - Also from the cells, before the Corrective Services (Jailers) will accept him he needs a medical clearance letter because he 'appears' to be effected by drugs. That would be the psych and addiction meds he's on but they need a Dr's signature not mine so I slip him up to the hospital and the Police have the clearance letter before I've even completed my paperwork.
30M - IP, sleeping on the grass on the nature strip. Community Watch who had rung it in were standing around amazed at how I was able to revive him (wake him up) with just my voice and a very bright torch. Crissed as a Pricket, all answers were always the same, the suburb he lived in. Having searched his pockets and found nothing with an address we did the basic medical checks on him and found him to be healthy, suddenly the booze fog lifted and he told us this was his address. A backpackers share house he knew now how to get in and there was a room with his stuff in it. We left him to go to bed.
41F - Rang the Medical Advise line after taking a second antihistamine tablet for a localised reaction on her upper lip only to an unknown allergen. They auto-defaulted to sending us. There wasn't any airway involvement and it was going down while we examined and consulted with her so we left her at home with a strong recommendation that she does see her LMO to get this followed up before it does turn into a full anaphylactic reaction.
3F - ? Asthma, run hot clear across the city to find another crew already there (different division, different radio channel) who had been asked to checkout the pt and have us Tx. The parents had panicked and they were completing non transport paperwork so we went home.
87F - Family Christmas celebration and no-one was helping Nanna walk the dark path slightly inebriated. Some simple abrasions and left them to fuss over her.
32F - IP at home, had been making too much noise and the Cops and us got called to investigate. Nothing medically wrong and we all helped her to bed and left a very embarrassed young lady.
40M - accused of sniffing butane gas (cigarette lighter refills not BBQ bottle) by hostel staff. While not a safe or advisable action, he was not impaired and so I wasn't about to remove him from the premises they'd have to follow their protocols and do that themselves.
??M - Very IP put in a holding cell by Police for being a public nuisance. They called us after he had began beating his head against the fortified glass and steel cell front wall and had knocked himself out. On our arrival he could be heard continuing his assault on the wall and we were dumbfounded to watch the ferocity with which he did it. This was not the one man custody dock which allows you to only sit or stand but a larger holding cell that could hold 30 people and he was taking a running start 3 meters or more back and launching himself against the wall like a soccer player heading the ball. It had taken 5 officers to get him in there we were told, while we formulated a plan, mechanical restraints, stretcher and more hands we observed 4 more attacks before he finally managed to split his head open and concuss himself enough for us to enter and apply the restraints and load him on the stretcher. He'd lost about 500mls of blood from a 10cm scalp lac and en route even with a Police escort still needed hands on restraint. We were not in any physical danger and the short transport time was better than waiting for an ICP who could use chemical restraint with a risk of stick injury always present on such jobs. We bat phoned the job to have a Resus Bay ready and security there. Suspecting a open head injury they did everything quickly and well as usual and The next shift we found out that the was no skull # and he was conscious and GCS = 15.
Reason for behaviour just intoxicated.

So ending the shift from a Police cell also!   



See you at the big One. Taz

10 December 2011

Variety

That was this shift.
Different partner.
Not so different work.
44M - Flank pain, most likely renal colic.
50M - Known epileptic, 3 witnessed seizures by us got all my available Midazolam.
93F - Accidental activation of her Vita-Call alarm.
43M - Suicidal thoughts.
23M - Heroin OD, his mates (who don't use) were giving him really good CPR including mouth to mouth. Standard protocol O2 and Naloxone brought him back. Transport to observe.
32F - Hospital to Hospital transfer.
35M - Rib pain after a fight.
20F - Too much GHB, were not able to leave in her motel room to sleep it off because of managements concerns. 20 minutes after triage she was straight enough to walk out and go to her motel.

See you at the big One.

Taz

09 December 2011

Summer is humming.

With work that is!

27M - Drug Effected, admits to suicidal thoughts.
62M - Took his wife's anti hypertensive meds and collapsed.
51M - Crush and massive tissue damage to left little finger after a workplace accident.
89F - Assisted living hostel to hospital for review of a wound.
82M - Assist to feet. Left at home.
43F -Abdo pain. Endometriosis.
70F - Chest pain.
22F - Syncope. Refused Tx.
30M - Fell at the train station and refused all assessment.
31M - Lac on left eye brow post work Xmas party fight.

See you at the big One. Taz

08 December 2011

Phone's

So I've changed my phone, or rather my ISP did with a new bundle offer for broadband and mobiles.
I've left the comfort of my Windows based smartphones and got and Android HTC Sensations.

Gone are the folders, now there are apps that look or sound like something you knew on windows but which isn't. If I wanted to send my peeps music, video or tweets this baby rocks but if I want to handle say PDFs or word docs it's a whole new heap of different that I'm sure is really just me trying to learn something new and different and will get easier and quicker and better the more I work at it.

I hope.

See you at the big One. Taz

Three nights straight!

I haven't done that for many years. It was the change of roster so I have to do one more shift before I get my days off and I get to learn about a new partner.

66M - Multiple co-morbidities, abdo pain.
30M - Admits to ketamine use at a dance party??? Go figure!
73F - Discharge to home (makes a bed free for later)
48M - IP, fell like a tree from the fifth step on the stairs, combative, left chest appears hyper inflated with some decrease in sound but no sub cut emphysema (it does take awhile to appear), bat phoned it in Obs fine, mechanism and GCS. Follow-up reported a cerebral contusion and a couple of chest tubes.
25M - IP clumsy fall landing on his ear. minor abrasion dressed and sent him home with friends and instructions.
21F - One day in the country and being seen by paramedics already! What a start to their Australian adventure. Dislocated patellate, that as usual relocated itself after some analgesia took their mind off it. Instructions and left to get some sleep and enjoy our country.
27F - IP, Hubby had been trying to get her home but had failed. We offered our assistance and provided safe Tx to a hospital bed to sober up.
23M - Claimed to have had his drink spiked and I will say here and now that there was something else in his system other than alcohol. Now we in the business do know that the act of drink spiking is not usually done to watch someone behave funny, it has a much more sinister reason that I will not go into but lets say this dude was conscious and aware of everything this night so I don't know what was going on other than pupils that dilated and sluggish, lip licking and hyper activity clearly indicated drugs. Hospital waiting room to chill.
71M - Chest and abdo pain and burning from his toes to his head.

See you at the big One. Taz

05 December 2011

Last night of the roster.

The night of the work Christmas dinner, some of my colleagues are confused by my decision to work instead of attending. It's simple, I've been attending Work Christmas Parties (WCP) for over 30 years, that's longer than most of my colleagues have been alive. WCP's don't get any better with age. I have been there, done that, enjoyed it and built a new reputation afterwards. I'm trying to maintain it.

25F - 2 witnessed tonic/clonic seizures, no Hx of same, c/o headache/migraine before seizures, GCS = 3 , O2 and 10mg Midazolam IMI with Naso airway because of trismus, Factor 5 clotting disorder medicated with Clexane (Enoxaparin), we're in the middle of a concert, she's 30 weeks pregnant and her airway has some stridor. Load and go, the nearest facility is 2-3 klm as the crow flies but without any maternity facilities at all. We got there is four minutes through horrendous traffic with suction being the only addditional Rx.
No Hx of pre-eclampsia BP was 80 systolic on scene, bloods we're told were normal as was the CT, bub's heart was loud and strong, pt tubed and a retrieval team collected for transport to an appropriate facility for both Mum and Bub.
Have a third officer with us from one of our motorcycle's, before we even start to clean the radio asks if we could attend a witnessed cardiac arrest with CPR in progress at the main train station? Hell yea!
?60M - Asystolic arrest, effective CPR by rail staff who witnessed the event while talking to the pt. A vehicle from our station beat us there by seconds, well run job with all the boxes ticked for pt care and safety but the outcome was never going to be good.
23F - IP, who's friends took much offence at us for suggesting that she was drunk despite their own admission to alcohol consumption for hours. They had planned to take her home but when she couldn't walk it must have been something else and so called us. We finally convince two of the more rational friends and the B/f to take her home. A few hours later at our local hospital who do we see in the vinyl recliner chairs that we affectionately call the Vomit-Tron? Yep her, diagnosis by a Dr now, intoxicated.
??M - I'm still scratching my head as to why an Emergency Ambulance was dispatched to this. Response is a complicated and lengthy computer algorithm in response to the questions asked by the call taker. I can usually understand the pathway but can only guess that there were just too many unknowns and that set off too many red flags that activated a response, it wasn't lights and sirens but in the notes that came down on the MDT it read, 'pt wanted to talk to a female voice about his sore feet and that he had nowhere to sleep currently'. Not unexpectedly we couldn't find the caller when we arrived on scene.
63F - Abdo pain.
28F - IP with friends who for some reason were telling lies badly about who they were and what was going on. I believe there was nothing underhanded or shady going on they were just lying to the Harbour Rangers, Me and then the Police, it was stupid. In the end I took the IP female away to the safety of the hospital Vomit-Tron for her hubby to collect.
21F - Respiratory Distress or the good ol' panic attack. It took awhile but she calmed down.
25M - Near syncope, left to go home.
23M - Assault by individuals drunk and violent.
28F - Minor Head Lac. Refused Tx.


 

See you at the big One. Taz

I appear to be doing Bupkus!

But that is not true, after the shock of not having a new Padawan to mould had worn off we got really busy with quantity. So much that I've been to tired to post.

85M - Anxiety is what I would call this job. He had an extensive bowel Hx but that had been good for the last two years but today after some straining there was some blood on the paper and a little in the bowl. His specialist obviously didn't know where he lived because he told the pt to get an ambulance to take him the 700 metres to the hospital.
52M - 'Tis the the season to be golly, and pissed and not yourself. A rude introduction to the darker side of his partner after being together for something like 20 years post a festive drink or three. We arrived, evaluated took obs and advised that the mumbled speech, vomiting on self, urination inside of clothing and unsteady unfocused gaze were all alcohol related.
48F - Police on scene with this person about an unrelated incident saw there was blood on her hand and got us over to check it out. Dressed it and left her with them.
30F - Suicidal thoughts with a plan and was acting on it but there was a spark of doubt that allowed us to intervene and hopefully get this lady on the path to a better life.
60F - Drowsy at a Women's Refuge. Known drug user was too drowsy for them to look after, they provide accommodation nothing more. Refused all aid and assistance, abused the staff and us and eventually left.
26M - # L Clavicle.
56M - Back pain, muscular mostly by it's location.
42M - Opiate OD, 800mcg of Narc brought him up well and he refused transport but accepted advise given to the friends on management after we left (NO MORE GEAR, no booze and ring us back if your not sure).
73F - Skin tears. It's just before breakfast (for the normal people) and they don't want to go to the hospital but these need to be looked at by specialist today, they're to bad to leave at home as I'm unable to get the skin on the large one unrolled back over the wound. A compromise,  they'll go up after breakfast and see her LMO with a copy of my case sheet to indicate my concern and Rx.

Not a bad nights work but too busy to learn much about my new phone. 

See you at the big One.

Taz

01 December 2011

Met my new Padawan today.

The classmate of our student ride-a-long that is and lost her by the end of shift as workforce had been forced to shuffle their postings. Instead for the next roster I work with a peer. We'll have fun and that's what counts.

Call to triple 0 (the 999 or 911 equivalent in Australia) that was hung up, no actual spoken word heard. A street address was located from the caller identification that turned out to be about 50 apartments. The call back went to message service and without the apartment it was UTL.
27M - Nausea, vertigo and 20 odd ED presentations in the last year for various ailments at different hospitals we found out at triage.
35M - Suicide thoughts and a weak plan to attempt it. Could do with some more focused management than has been supplied so far.
41F - Severe sudden diarrhoea, several motions. Recurrent gastric infection that caught this very normal Mum with her 5mth old out in a large department store.
77F - Syncope fall with minor head lac. Language barrier so Tx for better assessment.
46F - Very long attention seeking mental health Hx who wasted ours, the police and hospital staffs time by knowingly stating that she would throw herself off a tall building. Has been saying this for 6 years at least. Not seeking any barbiturates or other drugs just likes the attention we have to give in case this girl who cries wolf means it one day.
??? - OD in an even bigger block of council flats, a real misery towers. No block number, no apartment number, no pts name or details! What are we magicians? UTL
??? - Same place for the same thing an hour later with no more details, someone's getting the jollies watching us run around like fools. UTL
17F - Near syncope while attending the taping of a music video for latest teen heart throb here in Australia.

And that was the last day for our ride-a-long, good luck to him with his exams in the next two weeks and I'll see him at the next big one as a probationer.

See you there too!

Taz

29 November 2011

New Week and new work.

It's the last week of the roster and G and I work all four of the last shifts.
It's been an enjoyable roster and we've had fun but the work has been short until today.
With a ride-a-long from our education centre the quality was so so but the quantity was there.

44M - Motor bike V Car, minor abrasion on the lower leg elected to self manage.
53M - Painful cellulitis.
53F - Pre Syncope episode on a crowded train and so she called us. Left to self manage after a calming chat.
91F - Fell two days ago and Hubby hadn't called us yet attempting to manage at home. Mobility was now a real issue and we Tx for an X-ray and there was a #.
87M - Multiple problems but mostly extreme lethargy, renal failure leading to beta blocker toxicity and severe bradycardia.
37F - Abdo pain. 28/40 gestation, a bit of a panic and call us Tx to Mums an' Bubs for a check up.
Sailor on a base gave himself a minor lac on the forehead and called us and the base medics. We got there first and cleaned it up and handed him over to them.
62F - ? Anaemia.
25F - Police were concerned after they saw all these little cuts on her arms and leg, new and old. Called us thinking it was a possible suicide attempt. I had a talk to her and she was pleased that I knew what they were, her control valve for her temper and moods with un-medicated bi polar disorder and addiction to heroin and cannabis that she's trying to kick, it was how she controls the rage. All understood now I left her be.
88M - Left groin pain not like a stone, idiopathic.

 
See you at the big One.

Taz

27 November 2011

Two extra jobs this shift but really!

32M - IP who stated that he was looking for the local cliff to jump off. Had asked directions???? Mr Police and me get called. Yes he has some issues and they only seem to surface while drunk or so the wife says. We transported a very nice, troubled guy to some help.
38F - IP who had an anxiety episode on the train. Fully resolved well before we arrived but her brother wanted her checked out?
16M - Lovely chap this one, full of piss an' wind and all the hallmarks of being a fruitful and successful member of society. Left in the care of the poor constabulary as we had nothing to offer him.
38M - Don't get in-between girls when they're fighting on the street drunk! Copped a stiletto in the ear for his troubles.
19F - IP, threatening self harm, had a 12cm (6") knife in her handbag. Transported.

See you at the big One.

Taz

Still not much work!

What do you do if you've washed it, restocked it?

61M - IP, know to the staff of the hospital and myself, abusive usually but too far in the drink to string and coherent abuse yet.
55F - Minor scalp wound. Happy for her to continue home and self manage.
48M - Seizure or was it. A known sufferer of seizures but on first examination while I got the Midazolam drawn up I put it off to one side. It wasn't quite right for a purely epileptic seizure. Long story short he got some Midaz because there was something that looked like a seizure later and while I had a feeling, if it had been wrong and I hadn't given my drug where would have my duty of care been. I don't have the knowledge of a Dr or the imaging or other diagnostic aids available in a hospital with me seven flights up in the patients bedroom. Treat what I can, do no harm and ABC.
37M - Got a bystander to call and claim suicidal intent. Didn't like it much when we took him to the nearest hospital because he'd already been there and escorted of the site for abusing the staff after they didn't respond immediately to his demands for food and a bed. It was too late to call up the shelters and hostels and he didn't like that.

See you at the big One.

Taz

21 November 2011

Way too slow for my liking!

There doesn't have to be trauma galore but at least a quantity of work for starters please.

Four jobs all day and while I acknowledge that my attendance and the pts condition was very important to them I wanted more!
41M - Back pain.
97F - From Nursing home to a Rehab hospital.
81M - Back pain.
42F - Had some premature contractions that were settled at the nearest hospital to her and we transferred her to her own maternity hospital for further treatment.

I would start to think about food if I was really bored before but what with no smokes that was it I bought food, health food but not normal for me and I even fell asleep on the couch at station because we had done all the car and our station duties.

This is embarrassing  for me.

I NEED MORE WORK!

See you at the big One.

Taz

20 November 2011

Managed to get to work in one piece.

The hand is still swollen and sore but usable.

25days M - Gave his parent a shock and they called us. All good and we transported for their peace of mind.
35F - Big night on the town with her G/f's and not much sleep and when they did wake up lets go and sit around a pools and soak up sun and have a fatigue/alcohol syncope looks like a seizure episode. Left in the care of the G/f"s and some more sleep and hydration.
89F - Expressive Dysphasia and aura, maybe a TIA resolving in front of me but needs to be followed up on.
53F - Minor head injury from a fall. Left in own care.
22M - IP, backpacker.
??F - passed out on a bus. Cops got there first and woke her up and will take her home.
75M - Fall resulting in a not major head lac.
21M - IP, woken by Police and still not retaining info at triage.
83M - Deceased.

See you at the big One.

Taz

18 November 2011

I went to the waiting room!

So I went for a ride today to enjoy the day and to stretch these recovering lungs and other body systems so I had a 30k or 20m ride yesterday and the plan was to increase that today.
At the 15k mark I had a stack, while going around a pedestrian walking as he should on the footpath I went on the grass and the difference between the grass and concrete as I tried to rejoin the pavement was missed judged and I fell to my left and the outstretched hand.
He helped me up and asked if I was alright, I said that I was and off he walked.
I tried to use my hand and couldn't and in fact felt some internal displacement and pain. I've never broken a bone and have only felt others on the job.
I walked for 10 minutes before thinking I really need to get home so I jumped on the bike and slowly and often painfully rode home. I knew I needed an x-ray by the time I had got there and the wife wasn't home so I grabbed some things after failing to contact her on her mobile and was about to drive myself (in my manual/stick shift) car when she called and said she would be here soon.

We went to our local A&E and used the public entrance and thank you to all my allied health professionals was seen very quickly. Diagnosis before was possible fracture of the 4th and 5th Metacarpals from swelling and pain, not something I wanted even if it is my non dominant hand.
X-ray was clear, thank the cycling gods, and I just have to get this swelling down in the next few days so I can return to work, don't want to miss something good!

The bike seems unscathed, I believe the wobble in the front wheel was more from one hand operation and the pain. I think that I had dislocated those bones and what I felt was me realigning them, also something I've never experienced before.

The wife gave me a silent blast for being a dumb arse in riding home but is also relieved that again this shows how careful and safe I ride when on the roads because all my accidents have been on footpaths or the like and around pedestrians.

As a present or reward to myself for giving up the fags I was going to be getting a new bike anyway!


See you at the big One.

Taz

I am amused!

By several thing actually.
I know that this is a simplified version of the troubles I had with management or rather the watchdog of management, I can't identify myself. Which state do I live in or city because that may alert you to which ambulance service I work for. If you already know me that doesn't worry them because it's logical that you would because you probably work with me. Doesn't matter how proud I am of my job and the people I work with it's managements policy.
But several days off ago I get a phone call, off the official record asking if I was going to a media event in the future? Would I reconsider? There was a possible photo opportunity with the family member of a patient so it's OK to be identified in full uniform posed with a member of the public full name listed when it suits.

It has now been eleven days since the wife and I stopped smoking.
We are not wearing nicotine patches.
We are not putting on weight.
We are not suffering any obvious psychological or behavioural problems.
We have been exposed to a night of alcohol and didn't want to smoke.
We have been exposed to working days and days off during this time, boredom and activity.
We have not noticed any changes so far in either of our bodies.

Does hypnosis work if you fall asleep during the session?
She spent $10 and got a Stop Smoking by Hypnosis DVD. I hadn't seen it but she has. It was a wet ol' afternoon so I got it and put it on. Apparently I was snoring during it. I woke up at the end and don't feel any different so I don't know but it was boring so I'm not going to replay it.

See you at the big One.

Taz

15 November 2011

To finish off this block.

51M - Post ictal, transported.
16F - Dizzy and slightly drunk with friends who were going to look after her till she sobered.
34M - Shot up some Heroin, fell over banged his bald head and cut it. Big enough to need stitches.
26F - Chest pain that was more likely pericarditis or the such.
26M - Sleeping on the floor at a MacDonalds. They called us, we woke him up, he went to purchase another burger and they served him.
51F - Off her meds, very disjointed abnormal behaviour and needs assessment.

See you at the big One.

Taz

Missed a shift.

Had a family wedding to attend and did a swap with someone and came back the next shift to,

37F - Depressed, just knew she needed to talk to someone.
Assist another crew.
??M - With a head injury, maybe, bystanders called and even told us the pt had left the scene. They followed him home and then waited for us. I am fully aware of the possible complications of a head injury. I am fully aware of concussion altered mental ability etc. I also respect independent free will and the sanctity of one's home and the right of an individual to decide if they need medical attention.
20M - Anxiety attack the co-workers thought was an asthma attack. I't wasn't and I cleared him to stay.
42M - Localised left shoulder pain that didn't appear to be atypical cardiac related and didn't want the go to hospital but will follow up with LMO and did have the two types of simple analgesia on hand that I recommend to take to get to sleep.
18M - Hearing voices, the booze, non compliance with medications and his confrontational aggressive behaviour towards the Police, Us, Hospital Staff and the general public meant this was only going to end up bad for him and lots of us were put in danger to protect the greater good of humanity. This is a story replayed over and over again on the News and current affair programs. None of us truly wish to deprive someone of their liberty by physical and chemical restraint but it has to happen sometimes.
41M - Well known frequent personality to us who work on the streets. Stranded in the city without money to catch a bus home. We take him to a waiting room for his safety and so his ?carer's? can collect him when it's light.
27M - Paranoid post taking LSD! Internal voice shouts 'SHIT DUDE THAT MEANS THE DRUGS ARE WORKING'  External voice reassures him that I am a Paramedic, I get my partner to put the beacons on to help prove it. A very sheepish young fella opens the door and agrees that if he feels like this maybe I should take him somewhere safe to be observed.
Young F - Fell backwards onto two thickly carpeted steps inside the house. As complete an examination as we are able to perform in the house finds no serious reason for the prolonged SOB she experienced that has now fully resolved and I believe that I am confidently able to diagnose she winded herself. Stayed at home.

See you at the big One.

Taz

11 November 2011

That was a good shift.

A little bit of Mental Health.
A little bit of Tonsils.
A whole lot of drugs and a whole shift to play in.

21F - Drug induced psychosis in a unsafe environment, transported against her drug addled will for her safety and treatment. Saw her hours later after the drugs had worn off and she thanked me and apologised for being difficult, which I didn't think she was.
31F - Swollen angry throat, tonsillitis maybe? Transport so assessment.
49M - Drug induced dystonic movement concerning the Police in the charge room. Time will allow it to wear off so they kept him there under their observation.
82M - Very localised specific right sided chest pain, I think it is m,ore the chest wall or pleura.
35M - Sore chest after a coughing fit. I can say no more. I didn't transport.
91F - Sleepy. Discussion with not so concerned daughter as Mum had woken up and was normal when we arrived. It's nicer for Mum to stay at home.
37M - Got sprayed by the Police with Pepper Spray and we had to decontaminate. Surprisingly he openly admitted that he was misbehaving and had deserved to get sprayed.
54F - Mechanical face plant on the footpath. Two minor lacs and a few abrasions.
45M - Seizure. Midazolam and transport.
28F - More tonsils playing up. LMO already treating with ABs but they're not winning the battle. The surgeon might be needed.
83M - Hospital to Hospital transfer for treatment on a failing heart.

See you at the big One.

Taz

10 November 2011

This is a 4 shift block.

With pressure of the blog meeting, the dental work, mother-in-law coming and a wedding to attend I didn't even post in draft any of the work from the last block.
I don't think there was anything really spectacular in it just run of the mill bread and butter stuff that is a normal shifts work for any Paramedic.


76F - Ataxia with increasing falls.
93F - SOB/Chest pain on walking on the flat.
43M - Hospital to Hospital transfer.
69M - Who's BP is normal now after he's taken his BP meds.
61F - Hx of atrial tachycardia and a 2/24 long episode today.
48F - SVT or ATach (there were some P waves) no Hx of either.
41M - Drug effected.
85F - Decreased mobility.
50M - Near syncope X 3.
72M - Gout and very painful crystal growths on finger knuckles.
81M - Urinary retention, known Hx of same.
Multiple Pts, 6 non transports and 1 for observation.
44M - Abdo pain.
53M - IP and depressed.
63M - IP unable to walk.
 35M - Vomiting.
19M - IP, wouldn't believe me that his current condition was alcohol based. When I was able to later tell him that he was 4 times over the legal limit to drive I think it was starting to sink in.
24F - Simple syncope at an event on a very warm evening. Declined transport.
??F - Unable to locate the pt.
19F - Abdo pain and diarrhoea for over 1/52.
19F - IP, parents coming to collect friends to look after her till they arrive.
64F - Can't get to sleep, could we check her BP, it was fine. Left at home.
23M - Minor abrasions from low speed motorbike V car. Left at scene.
60M - IP almost home. Was in his neighbours front yard. When this was figured out we knocked on his door and left him there.
86M - Hypo. Fixed and left with family at home.
26F - Abdo pain.
20F - IP Backpacker who also wouldn't believe me that alcohol was to blame for her condition (4x over). 
97M - #NOF.

And that was 48 hours worth of work for me and my partner.


See you at the big One.

Taz

09 November 2011

For the Australian Readers.

Australian National Paramedic Support Foundation

I received this yesterday and became a foundation member almost straight away.

I was happy to join, it seemed the right thing but you have to make your own decision.



See you at the big One.

Taz

How am I going without smokes?

Pretty well actually.
I had my last one the night before the post was put in my jaw for the crown and that was three days ago now.
The dental surgeon has little idea about pain and analgesia and I have been using a combination of simple over the counter medications that work better in combination. So the pain, swelling, stitches have been assisting me to not really think about smoking.
Neither of us have as yet found it necessary to put a nicotine patch on although there are numerous packets of  gum or mints around the house. Time will tell, for me it will be on my return to work and as a couple we have a wedding to attend so there will be the demon drink and it always wants a smoke.

I will be honest and admit to any slip ups but at this stage we're going good. 

See you at the big One.

Taz

The Wife said 'You always get good work on an extra shift!"

And there was, an interesting medical case, an OD/Cardiac Arrest that was philosophically discussed later, and the very first long term deceased my partner has ever seen and this was discussed by us afterwards also.

50M - Decreased movement. I know this person on a casual basis and I could see the unsteady gait. In the last 10/24s increased numbness/altered sensation in peripheries, vertigo and ataxia. No trauma current or past, no drugs or abnormal occurrences, no current or recent illness! Even more interesting was 12/24s later the symptoms were progressing!!!!
87M - Angina pain. Feels just like his last episode (10yrs ago) when they gave him 5 grafts. Started about 4hrs ago but has nearly gone now. The wife made him ring, God Love Her. I think he was due for a check-up and this was a warning sign plus they never gave him any nitrates for emergencies.
2F - 2/52 Hx of respiratory illness not responding to pharmacology's and still quite unwell.
78F - Know trauma under treatment but pain management has gone out the window today.
29M - Opiate overdose suspected leading to cardiac arrest. No shock just O2, CPR and Narc with Adrenaline resuscitated the body but here's where the philosophy comes into it.

A young fit ready to live body was probably always going to respond very favourably to our treatment. But what of the brain. Our clinical pathways have been developed further to provide times researched from evidence based best practise to signpost when we may consider not starting (example;15/60 asystole with no CPR prior to our arrival). We arrived well inside this but how long had he been down before discovery?
Everything we did was correct and textbook and generally what is believed to be in the pts best interests and nothing in it would I change but it makes you think?

90F - A beautiful person with a loving family who needed all the TLC I could muster and it was my pleasure.
73M - Found outside on a footpath unable to stand or walk but appearing to make sense in conversation (there was a language barrier) no wallet or other ID and then I find the chocolates in one jacket pocket and the sugar cubes in the other?! A Hypo, easy to fix, contacted the wife (they did live at this address {every noticed that, how many hypos almost get home}) and release him to her care after we get the BGL up.
??M - Deceased. There was no need of us to enter the room. It was obvious from the hallway downstairs but my partner had never encountered this type of incident and there were resources rushing to help us if I didn't call them off. I'm sorry that a person that I didn't know has past away but is a common part of our job and one that must be dealt with professionally. Disturb the scene as little as possible and tell the Police what you did touch. When you can handover to the Police get away from there and discuss it with your partner. None of us are invincible to the constant exposure to what we see and this one may be what breaks the camels back if not managed properly. Most services have either Peer Support or Counselling services, use them because we need you out here with us.
83M - DVT, after getting unloaded well all day this the last one of the shift cocked us up, 2 1/2 hours overtime on the last job.

See you at the big One.

Taz

No, that's not what I wanted!

More jobs came down but there was no quality!

66F - Hosp to Hosp transfer.
82M - Had a fall, got a black eye but refuse rational transport offer. This patient was able to display competency and capacity in deciding that he didn't want to go to hospital, he was able to believe and understand that 20% of his face was so badly swollen with the contusion that he couldn't open his eye. That the very slow drip from his nose was probably haemorrhage from the eye draining via the tear duct. He understood mine and the family's concerns for possible loss of vision, stroke or even death from inter cranial injuries but still refused. We were all involved in the discussion, pt, wife, adult children and us. The pt has the right to a bad choice.
43M - Hearing voices.
19M - Epistaxis from a friend.
26M - Drug effected.
25M - Drug effected.
19F - Alcohol effected.
89M - Assist to feet, no injury.

Got a shift swap during the days off to allow Ambowife and I to attend a wedding next month, these usually bring good work.


See you at the big One.

Taz

Work's slowing again.

 63M - IP, that's not the problem it's his argumentative friends who keep ringing us to take him away to stop his drinking all the while they are there drinking with him. Pot calling kettle black?
87F - Abdo pain.
86M - Assist to feet, no injury.
23M - With one of the best #noses I've seen. It wasn't splattered but the way it moved when I touched it!!!!!
62M - Drinking Diesel!!!!!! but wants to go to hospital for a shave and a feed.
30F - Self harm thoughts.

See you at the big One.

Taz

Started as a day of Abnormal Behaviour!

37M - Two bottles of dexamphetamine's. Totally compliant but if he hadn't started to randomly shout gibberish at passers-by and totally pinging off the walls the Police wouldn't have noticed him or called me. He got a little fiesty in the ED and was given something strong to help him sleep. For his protection and that of staff and the public.
37F - Threatening everyone harm. None of the threats were believable but just wouldn't stop making them. It appeared to be an attention seeking action and it got attention.
45M - Huge anxiety attack, poor fellow very debilitating, a massive PTSD history that made this very nice quiet dude an emotional wreak. Physical violence is not the only way to harm others.
94M - To a Hospice.
53M - Acute back pain non traumatic.
59F - Chest pain. Not cardiac.
Baby fallen from knee height. No injuries apart from Mum's confidence. Apart from the actual birth experience this was possibly the most traumatic thing to have happened to this pt and it scared the shit out of them. I have found that the baby is usually very quiet and withdrawn post incident and before we arrive but if they're starting to return to some of their normal interaction (crying at the sight of me, all babies do?) movement and normal eye movement that the old idiom has some merit 'Babies do bounce'. Transport for observation was accepted and is always offered.

See you at the big One.

Taz

08 November 2011

14 Jobs on the Data Terminal screen!

But only ten case sheets written, called off the others for either a closer crew or the caller cancelled

27F - In a motherly way and had to endure a 30 min bus ride standing all the way (where has chivalry gone) and had a faint. Declined transport.
59M - Just an odd dude that the Police wanted us to discover if he had any mental health issues. No just someone who is different.
?50M - Unconscious, maybe drugs pharmacology treatment not successful. Follow up was poly-pharmacy OD, amphetamines, opiates and alcohol. He was still in a higher care ward when I finished this block of shifts.
81M - Left chest pain from his Drs. Not cardiac related.
22F - ?Syncope, maybe pregnant. Took to hospital for a check up.
64M - Tachy at 180 in AF.
27M - Dislocated left shoulder and watched an ER Dr massage it back in, awesome.
32F - Heat stress/exhaustion. At home and understands self management so we left her.
55M - Has a broken arm that hasn't been put in a cast while waiting for the swelling to reduce. Couldn't remember how to put the sling on that had been provided. Called for an ambulance, neither of us have ever seen this sling set up but we figured it out and put it on the pt and wrote him some instructions for next time.
83M - Haematuria and urinary retention.

This was a draft post from the day I was told about the complaint about the blog. In hindsight I don't think that I'll review and repost the older posts 'cause that will just be a real pain in the arse for you readers, in particular those who follow and get updates on new posts.
They won't be new and I don't think there is any literary brilliance in these pages unlike some of the prose in Insomniac Medic's blog

See you at the big One.

Taz

06 November 2011

So what's happening with the blog?

Lots actually.
A lot of the content has disappeared, well everything has apart from the last two posts. They're not deleted but reverted to drafts so I can review each and every one and alter to meet the agreed upon format from my meeting with management.

Firstly I'm very pleased to say while not supported or endorsed by my employer in anyway they are happy with most of the content of the blog, it is obvious that I am very proud of what I do and I write in a positive and complimentary manner.

I must mystify myself more so that I may not be recognised by new readers or followers and to that end my profile has been altered I work in Australia and I'm a Paramedic. I can not have photo's of myself in uniform that may identify for whom I work and/or where I work. I am not to post any photo's that may identify what I look like out of uniform to again protect my confidentiality and safety and there by my patients.
I'm a little unclear on this one when I have been filmed several times in a reality TV series that identifies me but that was in a public place and I was not making comment but only doing my job and was approved by the powers at the time.

My comments are largely OK but I must be mindful of being misquoted, taken out of context or misinterpreted by the uninitiated to the word and phrase that most of us understand universally.

There will always be those that sit in the shadows and complain, hell I even have a gripe every now and then, it does good to get it off your chest but I happy that this matter is done an' dusted and this should be an end to it.

See you at the big One.

Taz

01 November 2011

Lookout World, I'm giving up the Smoke's!!!!

Yep after 33yrs of cigars, tailor-made (normal) or roll your own cigarettes, pipes of various shapes and the few odd 'herbal' cigarettes I'm officially off them from the 7th November. 


I was going to do this next year when I do officially turn 50 but I am having some dental work done with a whole crown done on the above date and was told the best chance of success was to also stop smoking.


With several thousand of my own dollars paying for this I decided to bring it forward.


Combining that with giving up sugar in my many cups of coffee, Dr said my triglyceride was elevated at my last blood test so I had to stop eating lollies, cakes and drinking all the soft drink that I must! Problem was that I don't, I know I have a sweet tooth and avoid that stuff because I was fat twenty years ago.

I don't mind the unsweetened coffee but I have been noticing a small lack of late shift energy.
The smokes well there are some people out there I work with who have never seen me smoke, I seem more physically addicted than mental I'll still carry the Zippo for awhile as well as a lot of gum. 


So maybe BEWARE TAZ the AMBO he may be a little jumpy and hair triggered for a while.

See you at the big One.

Taz

19 October 2011

There will be an interuption to service.

There has been a complaint to my employer by someone about some of the content of the blog, so with my best interests at heart I will not be posting about any new jobs until I have had chance to sit down with some managers and sort out the problem.

I shall been posting about Para-medicine and all related topics as I feel like it.

A friend of mine has a new book being released next month in print and electronic

Paramedico  A true and entertaining account of the paramedic author’s adventures working on ambulances around the world, from Mexico to South Africa, via Pakistan and Iceland.

I'll be going to the Sydney launch, if your in the city why don't you come too.


See you at the big One.

Taz