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

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

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

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

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

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

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

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

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

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

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

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

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

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