1st half slow, 2nd half BUSY!

41M - Runaway from his group home, likes the lights in the city. We transported for Police to a hospital waiting room for his carer's to collect.

83M - Chest pain, for about a week. Transport for bloods at least.

89M - Found in a train station confused. By some wonderful detective work we got a phone number for a family member and they came to the hospital to collect him. He is just starting to wander because of his dementia.

MVA x 2 cars - No injuries, no ambulance services required.

?30M - Sleeping in a bus shelter, woke him up and moved him on after he refused offers of a lift to the homeless shelters.

37M - It came down as an electrocution but turned out to be a Tonic/Clonic seizure in someone who ?? didn't have epilepsy. Goody, first seizure. No such luck turns out he is just non compliant with his meds.

47M - IP whom Police thought was fitting, nope, needs a lift to a shelter but a cage truck will be several hours, so we take him and drop him off if the cops go first in the car to clear the way for us with the staff.

As I have posted before there is a culture amongst some of my peers that you call we haul to a hospital only,but if there's a safe alternative I'll try for that.

22M - Dislocated shoulder, 10mg of Morphine and transport.

30M - Dislocated patella, more morphine, splint and transport.

And I got home too late to see the main telecast of 'the wedding'.

See you at the big One.

Taz

About Drugs.

That is, the drugs I'm authorised to carry and administer.
The highest level of Paramedic in Australia is an ICP - Intensive Care Paramedic. There are additional specialist fields but ICP is the top of the totem pole.

An ICP and myself would care the following drugs;
Adrenaline (Epinephrine) 1:1000 & 1:10000.
Atropine 600mcg in 1ml.
Calcium Gluconate 1g in 10ml.
Glucose Gel 15g.
Fusemide (a Diuretic) 40mg in 4ml.
Glucagon 1mg in 1ml.
Glyceryl Trinitrate.
Hartmann's (Ringers Lactate).
Lignocaine (Lidocaine) 100mg in 5mls - Antiarrhythia's
20mg in 2ml - local anaesthesia.
Metoclopramide - anti-nauseant/emetic.
Morphine.
Naloxone.
Salbutamol - bronchial dilation for asthma.
Sodium Bicarbonate.
Aspirin.
Midazolam.
Methoxyflurane.
Oxygen.
Paracetamol.
Ipratropium Bromide - used with salbutamol for asthma.
Fentanyl, we use it via a nasal delivery spray.
Benzal Penicillin.
Amiodarone.
Influenza Vaccine - only issued before winter for staff or during a pandemic.
Ibuprofen.
Glucose 10% fluid bag.
Ondansetron.
Fexofenadine.
Atropine auto injector - only issued in a nerve agent is released.

Right so I'm not an ICP but there isn't much I don't have with me anyway.
Our education does direct you to independent clinical decision making but you can always call for backup (ICP) which works in the metro area but if you out the back of no-where with the nearest backup a two hour helicopter flight away????

That's why we have the drugs and are educated in their use and our max dose can appear large because we are expected to operate autonomously.

Lauren wrote a message about the pt I gave 30mg of Morphine to, my pain management protocol starts with,
Posture,
Oxygen,
Cooling (burns), irrigation for chemical burns or smoke irritation, cold/hot paks for various insect or marine animal bites,
Then drugs like paracetamol, methoxyflurane, fentanyl then morphine.

IVI morph, if it doesn't drop your LOC, can be given to 0.5mg/kg and then repeated 30 minutes later. Pain generally doesn't exist in the back of my ambulance, well not for long anyway.


See you at the big One.

Taz

Woo Whoo!

I'm not going to apologise, I love to be busy.

45M - IP, released for gaol today with no apparent support plan or structure. Because he is drunk and has taken his prescribed meds without supervision the men's hostel he is at can't take him without a clearance letter from a Dr.

29F - Syncope in a crowded noisy restaurant. A medical professional who was on scene and witnessed it confirmed a syncope and not a seizure. All obs were good and the pt was in the company of her husband so we were happy for them to just go back to their hotel room and rest.

??M - Outside a KFC drunk and vomiting. UTL.

??F - She was supposed to be unconscious and drunk but she got up and walked away pretty well when she spotted us coming up the Harbourside Promenade.

5F - This mother has a mild form of Munchausen syndrome by proxy. The child scraps a knee she will want to go to hospital, last night it was waking with a coughing fit and she must have a chest infection. As I've said before if the pt or guardian directly asks I have to take them to hospital. I don't believe that the child is in any danger and some officers may think that the mother is just over protective but I've been to this address several times.

20M - Dropped outside a Police Station be a taxi after the pt stopped responding. On the footpath he vomited and pissed his pants. Until we revive the drunk tank or sober up centres we have to take them to hospital.

24M - Facial injuries post Unknown. He was found by rail staff at a train station covered in blood. Right zygoma swelling, upper lip trauma from teeth, denies neck pain, was walking around on scene (nil motor/sensory deficit), intoxicated but not badly and AMNESIC to events and claims he must have tripped over drunk. Finally coaxed him onto the bed and a collar.
A check later found that the Police had come by to see him as they had clear CCTV of him being 'King Hit' by some random at a train station four stops away and dropping like a log face first.

Sometimes my posts may sound like I'm only to ready to not transport you but always remember I do gloss, cut short and insert an opinion that was not there on scene but I would never put my pts in harms way by not conducting a complete primary survey, if they stay around for one anyway.

??M - Drunk but with friends who were taking him home but some goody-to-shoes told them she was calling an ambulance. If she was that concerned why didn't she give them a hand.

22M - IP, found in an alley by nice people who after they couldn't wake him up much called us.
As we in the job know, we have special wake up skills. He got up for me!!!! His g/f was called and was happy to come and collect him. Another one escapes the ED.

22M - Facial injuries post assault. The nose wasn't broken but as the cops had the offender a Dr's letter about the injuries is another nail in the dickheads gaol time.

??M - Cut foot, had jumped in a taxi by the time we arrived.

And that was how I started Easter Sunday.

See you at the big One.

Taz

Pubs shut and the work drops off?

Now why would that happen?????
I know that the 2200hrs close for licenced venues on Good Friday is not going to happen other times, people do have to make a living, but when the alcohol isn't there we did 500 less jobs across the entire Division that any other Friday night!

53F - Nausea and vomiting, why call now, she's at work about to knock-off and the symptoms are two days old. Some people amaze me.

31M - Some very minor lacs after a drunk threw a glass at him and was promptly tagged by security. Victim unknown to offender who was just a pathetic unhappy little drunk lad.

35M - Psychotic, acknowledged it was drug induced from Crystal Meth use. In the very short trip, thankfully to hospital he was telling me some really bad thoughts and while compliant and thankful of our assistance the potential for him to turn violent was some of the most I have felt.

46F - Abdo pain, chronic liver associated, her normal meds weren't doing it and her tolerance to opiates was very high. She was distressed and I didn't think that she was seeking and I gave 30mg IV Morphine and in knocked the pain down a little and I had reached my max dose for her weight. Lucky we had arrived just then.

18F - Is an asthmatic but was having a panic attack about an asthma attack, you follow? The very mild wheeze was the easy part to fix the 50 minutes we were on scene calming and reassuring her to control the resp rate was the hard bit. All good in the end and we left.

78M - Well known dialysis pt to finish of the night and then wait for the rain to stop before I ride home,,,,,,,,,,,,and it didn't.



See you at the big One.

Taz

It felt like there was no good work around.

The radio was slow so at least no-one else was getting better work than us.

39F - Motor Scooter rider that the SUV driver who performed a U-turn in front of and stuck her, claimed he didn't see. She was doing all the right things, speed limit (50kph or 31mph), helmet, gloves, jacket, pants not a dress, good enclosed footwear.
He struck her from the side, knocking her off the bike and sending her down the road sliding into the side of a parked car. The mechanism was enough to take all precautions and we even considered pelvic sheeting but it was more lateral hip than pelvic girdle pain.
We didn't BAT PHONE it in as the pt was very stable, without skeletal deformity or neurological deficit. Discharge from hospital seven hours later with a hairline fracture in one elbow, that's it, we were all amazed at the lack of injury from the mechanism which was confirmed by the SUV driver and the poor dude who was sitting in the parked car (before he went in to work) and watched the whole event unfold in front of him.
We told her to buy a lottery ticket or two.

84F - Uneven footpath fall, a minor lip lac and she didn't want us or a hospital. Had a meeting to go to. Off she went

42M - Outside a men's shelter, drug effected. Needs to be observed until his GCS improves and they don't have the facilities there so we get called to cart him off to a suitable hospital (non trauma status usually).

49F - Syncope with LOC, that was from them putting her in a chair rather than lying her on the floor most likely. Has been to her LMO and is under treatment for a virus, comes to work, is running around like a blue arse fly and the body has enough and shuts itself down. We're happy with the story and the obs and she's going to start Easter early at home.

24F - Near syncope, just felt faint. Has also seen her LMO for a virus and also went to work today. The same road that we would have take to a hospital also has her LMO's rooms that have just opened and her home. We are all adults here, again the obs are fine so we dropped her at the surgery and left her to self manage.

59F - Chest pain, transport but nothing in it.

83F - Family called for her increased lethargy. Diet has been down for a few weeks but nothing else obvious, transport for work up.

71M - Collapse in the afternoon but had to wait for his son to arrive home to assist him off the floor. Son calls us against Dad wishes because his story was he was reaching out to open the fridge door,,,, and woke up on the floor looking at the ceiling. All obs are good the only thing not perfect was the AF my partner felt when doing the BP. But the monitor when I put it on was a textbook sinus rhythm,,, no it's not watch this it says as the rhythm changes to a 150 + sinus tach, 80bpm AF, 94bpm sinus, lets chuck in some PVCs and while with us all totally asymptomatic and without any pain. We took him to hospital and gave them an absolute book of all the various rhythms we had seen and the 12 leads I had acquied during the sinus, AF and sinus tach episodes

See you at the big One.

Taz

Ok so I made an error.

You lot all jumped on the error in the age of the period pain pt in the last post.
She was only 37.
I'm sorry.

See you at the big One.

Taz

The return of Relative calm

An Uncle and Aunty from Scotland and the Mother-in-Law have been staying with us over my days off (all of them at the one time).

The house was just too small with five adults in it and I'm glad to be back at work for a break.

76M - The call was for chest pain but it didn't appear to be cardiac maybe respiratory or even a mental health issue.

89F - Booked transport to hospital for treatment and review of her gross cellulitis.

47F - Severe rapid epigastric pain after taking codeine. I'm told there is a stomach reaction with some people but I'll have to do some more research.

374F - Period pain but she suffers from endometriosis. It's only the second time in 11 years that she has called for the pain but the last was only 5 months ago so maybe the time for a review also of management.

45M - Call from a third party for an intoxicated man. Police arrived first and found nothing and called us off.

7 monthF - Got a bump on the head when in Mums arms and Mum turned too quick near a door jam. She was cute a pie and a lovely child and Mum felt terrible for her first real pain since the birth. Left at home for Mum to observe.

See you at the big One.

Taz

Nearly broke my waiting at hospital record!

75F - Found by Police waiting for husband at a shopping centre. Shop owners had seen her waiting for hours and approached her and then called the Cops. They eventually found where she lived and took her home, no husband there but signs that one did in fact exist.
They call us because they know she has a medical condition but aren't sure what, Dementia.
20 minutes later Hubby found in hospital. Has regular overnight stays for a procedure and as they have no family, all their friends are a similar age to them & pt will lock any carer out at the first opportunity she stays at home by herself.
We judge that she is a little too confused today & although not ideal we transport her to the ED for the social workers to assist.

The hospital is backed up, 6 crews and the word is no offload until the morning.
The dispatcher reads a list of uncovered jobs over the radio.
My partner is treating and our pts a walker so I have a complete ambulance to respond in.
I grab a young firebrand from another crew and off we go.

88F - Dull chest pain, we are happy that it's not cardiac but more anxiety but we still transport for bloods and Dr assessment.

We've taken this pt to a different hospital, it was closer to her home.
The firebrands partner is unloaded at the other hospital and comes down to collect him and I have the pt now.
An hour and I offload.
Travel back to the first hospital where we are still nursemaiding our 1st pt as she will try to walk out of the department otherwise.
We takeover an afternoon shift crews pt so they can go home.
We get a bed and nurse for our 1st pt after five and a half hours.
We unload the 2nd pt an hour and a half after that.

Next job and we're not going back to that hospital.

23M - Punched to face, some teeth gone and bleeding. Transport for cleanup, dental referral.

16F - Has had her insulin and her BGL is still going up. Take to the same hospital as the guy above.

23M - Hops to Hosp transfer for Maxofacial consult.

59F - Epistaxis, BP of 200 SYS and recurrent bleeds of the last week.

And the ten minutes to knock off job,
Two car MVA from the Police who are not on scene and didn't arrive for 20 minutes after we did. No injuries very low speed.



See you at the big One.

Taz

Three jobs in the first hour!

That's how the night started.

1M - Choking on unknown, we got there quick but the 'apparent ' choking had ceased and he was now playing happily with his father. Back out to the car to do the paperwork.

40M - Hypoglycaemia, 1.3BGL that rose to 3.8 and then 4.8 with some hypertonic glucose gel, our job is done.

51M - IP/Depressed, transported to hospital but unlikely to wait to see anyone. They actually whacked him in a mental health room this time.

Then it was hours of waiting for jobs,

85F - Hospital to hospital transfer for an angio.

85M - Lung CA - SOB.

??F Locked in the toilets at a McDonald's, may have mental health issues. I think the caller may have some issues but the woman I spoke to was just in the toilet.

Hope it's better tonight.



See you at the big One.

Taz

I brought her to tears.

41F - Lower back pain, no trauma and she was in real pain. It's 3 in the afternoon and she hasn't been able to get off the bed since 7 this morning, not even to pee!!! I give her the talk, 'I'm going to put a little needle in your arm,,,,,,' we all have a similar speech before we cannulate. It's a nasty cube fossa but I don't miss, tape in the 20g while my partner draws up the opiate analgesia.
The pt hasn't been relaxed at any time since we arrived the pain is constant. Pain isn't allowed in my ambulance so I give 5mg straight up and you can see the pain drop and the pt is able to relax and she starts to cry with relief. She got 17.5mg all up which is nothing really. By my protocol I could have given her 45mg if there were no contraindications (LOC, hypotension, Resp rate,,)

76M - On the old rat bait Warfarin and has a nose bleed. We guessed 2-300 mls in the bathroom. It didn't stop for the two hours we were with him at the hospital either.

40M - getting on a train his leg slipped between the platform and the carriage. He got himself up and travelled another three stop before he got off to tell someone about it. Nil obvious injury, requesting a hospital, I asked triage later for a cement injection to help him toughen the f*%k up.

50F - Chronic alcoholic, the family rang but there's nothing we can do. An ED is not a the suitable place to sober up particularly as she's at home with family. She attends a detox center and has a councilor who is happy to see her tomorrow, why ring us. No transport.

77F - Chest pain.

54F - Developmentally delayed person who is known to every ambo. Lives in a group home and when one carer works she runs away.



See you at the big One.

Taz

After five days Off,

I needed the days off, to watch videos and forget work with just Ambowife, don't know how much fun she had with me in the house all day.

Straight back into it this morning,

81M - 2 days of repeated rapid AF, called us today because he's now SOB! No kidding. 140-150bpm that I captured before transport where reverted all by himself.

36M - Walked into a cafe and ordered a coffee and fell asleep. They claimed they couldn't wake him but I did and moved him on while they offered coffee that we had to refuse because we can't accept freebies.

40M - Hospital to Hospital transfer, renal colic.

78F - Playing bridge, witnessed to develop a facial droop and lean. We had her in the Resus bay with the Stroke team in 35 minutes from onset. We'll follow up tomorrow.

78F - CA pt going to palliative care.

23M - Lower back injury at work.

Sent to back up another car at a cardiac arrest but they called them dead so we were re tasked to,

44M - Acquired brain injury who falls in his house without injury and needs an assist up.

40M - Opiate OD, backed up another car, they did all the work.

63M - In a wheelchair, can't seem to find disabled toilets so after a few days of doing in his pants he or a do-gooder rings us to take him to a hospital for a shower.



See you at the big One.

Taz

Scam Warning.

I got a telephone call today from a female with a strong accent from the sub-continent, my phone screen just said 'overseas.

There was a second or two pause after I answered and then it rang on her end.

After asking if I was Mr R*&^le she then proceeded to tell me about the faults and error reports that her company had been receiving from my computer.

I watch a lot of TV programs online and the player crashes every now and then but I am reasonably computer savvy and then I have Ambowife who is a bit of a whiz not to mention our son the IT help desk guy, so when she starts to rattle off system faults to quick for me to fully hear and then wants me to run a system command so that they may fix them I pull the pin.

It's a common enough scam to do with the event viewer and will allow them to access your computer remotely.

So beware the Indian voice who asks you to run the command eventvwr in the run box.

See you at the big One.

Taz

One job too close to home.

35M - Who rang up himself and told us he was having a heart attack. Turns out he is an absconder from our local hosp who took off before they could schedule him.

20M - Transfer from hand hosp to higher care facility.

39F - Stomach pain? but she appeared to be more interested in paperwork from Centerlink (Welfare) that required a Dr's signature to allow her to receive disability payments.
She was no more disabled than me. Some kind of scam going on here.

30M - IP, had been revving up some other homeless people and the cops got involved. They just wanted me to say 'yes he's just pissed and not suffering any acute mental health issues that require assessment by a hospital' or words to that effect. Last seen being offered a lift to the train station to send him back home to the suburbs. Away from our turf anyway.

38F - 12 weeks gestation spontaneous abortion. A lovely couple who were taking it very well.

35F - Bi-Polar who was riding the Manic Train. Husband was doing a much better job than I was with my first wife when she developed these same symptoms but I was just a brick salesman and she wasn't yet diagnosed. The fact that I'm revealing this on the blog shows that this job was a touch close to home. I was forced to physically remove her from the home and to the hospital but once I had taken that form of direct action she did reluctantly comply.

50M - That some bleeding heart liberal thought was having a seizure outside the only hotel bottle shop I know that sells Methylated Spirits chilled from the fridge. He wasn't. If they're so concerned take the homeless person home with you and stop wasting my time on someone who doesn't want to see me, I'm for a medical emergency.

See you at the big One.

Taz

It took us all night to do this lot!

45M - Mental health issues. I can't remember what.

97M - Poor balance, every single ob was brilliant for a man 30yrs younger so I was betting an inner ear issue.

53M - Transfer from air ambulance to burns unit with >30% BSA partial circumferential burns.

91F - APO

31M - Heroin OD - Cardiac Arrest. There were two of them but the other can't of had as much because he was moving about and getting up as we walked into the public toilet. Pt remained asyslote and we called it after 20 odd minutes.

Big ticket item for the night was the successful use of an iGel LMA on this pt as part of the randomised trial we are part of.

See you at the big One.

Taz

We still use a paper work sheet or Pt Health Care Record that allows us to be able to respond to the next urgent job without having completed it.
Management are introducing an eMR or electronic medical record that will have many benefits but it's main draw back is the necessity to complete the document before you can commence a new job. In the city this is going to cause havoc.
One station trialled it and it was taking 30 min at best to complete but if the printed didn't sync or the hospitals dock didn't sync,,,, your fuc*ed.

So it was yesterday that my partner look forlornly at me with 30 min to end of shift an' said 'I'm still 3 sheets behind'

65M - Driver of one car in an MVA. Nil injuries, low speed, car still drivable but requested transport to spend the rest of the morning in the waiting room.

70M - Vomiting and Diarrhoea, we would usually advise them to stay at home if able to tolerate oral fluids rather that infecting the whole department with a tummy bug but due to other co-morbidity's we transported and he got a bed pretty quick so triage agreed with me.

12F - Fell of her horse. A little lumbar back pain with no motor/sensory deficit. Transport for assessment.

43M - Partially homeless dude who has shocking left deficit post CVA 2/12 ago and refuses to do rehab or claims nobody offered it to him????? Police thought he was pissed also but that was just the CVA. Transport for community welfare.

25F - On the methadone and still a bit drowsy after her hit this morning. A bit of O2 and some conversation woke her up and generally improved her GCS. She had been seen sleeping in a doorway for most of the morning so the main drowsiness post the Done was gone. We spent 20 odd minutes and she left the area to go home.

87F - Syncope. I was happy that it was just a cafe syncope, hot sun, a little wine and some food but we transported anyway and this lady was normally an active healthy (no medications at all) person.

35M - What would you think if you found a guy drug fuc*ed, GCS = 7 (1,1,5) with three disposable mobile phones and 3 an' a half large in his pockets? He's been sampling his own wares a little too much! We and the Police did. They took his property for him to attend the station and collect when he felt like it and we took him.

68F Street fall, managed to hobble home but her knee got worse and there was a nasty lac on her elbow that needed stitches anyway.

Not a lot of work but it didn't really start until mid morning anyway.



See you at the big One.

Taz

A bit of trauma, a bit of gastro and a bit of stupid.

Seems like a normal day then.

37M - 2 day headache, he gets points as always for having taken some analgesia and one more point for ringing when it didn't get better. Got no idea what was wrong with him because everything was normal.

84M - Regular dialysis pt.

29F - 10yr old back injury that has mostly been managed by her and her chiro. 6 days ago reached sideways for some pillows on the couch and felt something go. Has been trying analgesia, anti inflammatories all to no effect and today she couldn't get of the thin mattress she has been sleeping on rather than the soft bed. Some Fentanyl IN eased the pain enough to walk to the vehicle.

61M - IP, seen by hostel staff to walk/stumble into a wall and cut open his eyelid. It did need a stitch.

31M - Industrial accident. #middle finger.

31M - Vomiting after parasailing and a ferry ride. Motion sickness you say but the symptoms got worse not better on solid land even after more than an hour. Hx of pericarditis and calcium deficiency.

43F - Claims to have been vomiting, what she showed me looked like some water and bread chunks. Worried about the hair she found in a cheese burger, she hadn't eaten the hair, it was intact. Stated that she was worried about what she could catch from someones DNA? Gave her an IMI for her vomiting and left her at home.

34F - Checked out after a very minor MVA.

45F - Multiple cardiac issues flown in from overseas, was GCS 15 on departure arrived 6. Retrieval team Dr asked if I was authorised to R1 transport to the ICU expecting our pt. Sure can Doc.

Last two shifts, last job from the airport, both pts very sick.
I'm starting a trend.

See you at the big One.

Taz

Shift swap today.

I'm working at my old station so someone can go to a wedding.

86M - 15min of lower left quadrant pain at midnight. Another lot at 6am. Decides to go and see his LMO at 9am. Rings a friend to tell them he'll be out and they convince him to ring us to check him out first. He was going so well with his self care. In the end we decided that him taking himself off to the LMO was a much better use of his time.

73F - Assist to feet after a stumble. Uninjured and entered into our falls research study.

65M - 2/7Hx of headache unrelieved by analgesia, no trauma, no motor/sensory deficit. Transport for more tests.

88F - Vitalcal alarm activation, no voice contact. Cancelled en route by a relative.

75F - Syncope in a bookstore. Uninjured declined transport.

69F - Right back pain. May have been from a fall but hard to gauge as the pt suffered quite severe Parkinson's and Dementia. Transport for X-rays.

48M - Winded himself after a fall at a soccer game. 30min later he asks the St John's volunteers to call us as he is still very distressed and having a hard time breathing. They have been giving him O2 I think there is a decrease in breath sounds on the right as well as less chest inflation. Transport for a chest X-ray.

80M - Severe haematuria, flying in from a country hospital. Probable complication from a TURP he had 2 units if blood before departure, 2 more in flight and looked like shit when he arrived. His BP dropped 10 points during road transport with us and I jumped 2 crews waiting for triage due to his deterioration.

Last pt was the sickest and there was nothing to do but get to hospital quickly.

See you at the big One.

Taz