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Contemplating life.

Paramedics Australasia conference #4

My first conference presentation was quickly approaching. There were a few hiccups regarding my time slot (tip: if a presenter drops out, don’t move the other presenters forward – people won’t know, even if an announcement is made), but I managed to start on time. The was even an audience, believe it or not!

Things ran quite well, some good questions were asked and I received positive feedback. I’d love to give you the presentation right here and now, but I am presenting it at my university’s e-culture conference next month, so I’ll wait until that’s done and then pop it up here.

Back to the highlight of the conference:

I was especially keen to meet with Gary Wingrove during the conference – as a founder and driver of International Paramedic, he was a main target on my conference radar. Plus, I had been told earlier that day that there was a conference call on to meet with other IParamedic supporters, and to build upon the inaugural meeting in April.

So after a quick dinner I headed down to the conference call room, and jumped on Gary as soon as I saw him. I think I may have startled him a little, but that quickly gave way to the history and potential direction of International Paramedic. Laid back yet determined, Gary and I discussed the parallels between the International Roundtable of Community Paramedicine and International Paramedic, his thought and my ideas of getting involved. Then it was time for the conference to start. 17 people, 4 of them on the phone – and I got to audio meet Scott Kier, which was a cool surprise!

And sitting in that conference room, I realised that I am sitting in a room with 17 people,   Paramedics from all over the world, and that this is possibly the forefront of the international movement forwards and together for paramedicine. A truly global initiative, with a truly global perspective. Something never done before, but badly needed. And started by über-passionate paramedics, now involving students, academics, government officials, the lot. I’d recommend to keep an eye out for ip, and more importantly, feel free to contribute and take part yourself (for example, the google groups have some great discussions going on)! This is EMS 2.0 taken from the textbook as it being written, and turned in to practice. This is something we can shape. Influence our own profession. How effing exciting is that?

The call came to an end, but not after everybody on the line was encouraged to pitch in ideas and get some direction for the future – getting international representation, putting out documents for international comparison of systems and services, internatoinal exchange and more.

This is the stuff that really gets me excited – the world of paramedicine is growing smaller!

 

Paramedics Australasia Conference #3

Day three in Sydney was another early morning start, with a slightly nervous yours truly, as  it was to be the day of his first conference presentation. But first, there were talks to attend:

 

  • “What can Australian paramedics learn from the modern battlefield” by Col Dr John Crozier. apparently, we can learn that if the enemy shoots at us, we should shoot back. The first half of the presentation was very military focussed, and I found myself tuning out a lot because, you know, this is a paramedic conference, and not a manual of “how I won the war”. Finally, though, we got in to the clinical side of things, and my parasympathetic responses began to be suppressed: wound clotting bandages in general have come in to a recession, now that they are not as good as they thought to have been. Tourniquets are a last measure for haemmorhage control, but when used are life saving. An interesting fact that was points out was in regards to tourniquets in surgery: patients can have tourniquets applied for hours in an operating theatre – surely we can too in an out of hospital environment? Thing is, in the operating theatre, the patient is a) in a controlled environment, and b) generally haemodynamically stable. So 60 – 90 minutes is the general consensus to leave a tourniquet on. One last point of interest was the fact that 28% of tension pneumothoraces were missed in the battlefield, which was traced down that clinical signs don’t always tell you what is happening to the patient. Time for portable ultrasound, in my opinion!
  • “The history of paramedic education” by Dr Ric Bouvier: hop in your Delorean, dial in 1950, and slowly drive towards the now, and admire the view of past education systems and general progression in our profession. Ric got the audience on his side early on with the witty but accurate comment: “I’m glad to see so many paramedics without balls here!”. He was referring to the nearly 50/50 gender split amongst paramedics in Australia – not bad seeing that (depending on the state) females were not allowed to work on the frontline 20 – 30 years ago.
  • Professor Hugh Grantham continued with the topic with a very clear and informative presentation style, highlighting the journey from Ambulance Driver with a first aid certificate, moving up the ranks via structured courses, diplomas and now to tertiary level educated clinicians, driving research via Masters degrees and PhDs.  “Paramedicine needs to be driven by paramedics. Paramedics need to be driven by patients needs.” His quote sums it up nicely – history has shown us that instead of taking the patient to care, care needs to be taken to the patient. And for care to be take to the patient, quality caregivers are needed – decently educated paramedics. And who better to look after our profession than our own?
  • “Community Paramedics – here, there and everywhere” by Gary Wingrove. Gary brought up some great issues, such as that paramedicine needs to adapt to the needs of the community, and to coordinate these changes and learn from each other there needs to be an international exchange – this is where the International Roundtable on Community Paramedicine (IRCP) comes in . Other things he mentioned were…oh…umm…I have to admit, I got a bit sidetracked during Gary’s speech. Not because it was boring or I was disinterested, not at all, but because Gary is also a founder and leader of International Paramedic – and his talk had very many parallels and good idea for International Paramedic. He would talk about something, and that would trigger my mind off in to a world of thought…so, sorry Gary! I’ll make it up with a dedicated post to International Paramedic.
  • “A model of paramedic decision making in cases involving pain” by Bill Lord. A very interesting subject, as I believe we generally under treat pain in patients. Also a very tricky topic, as pain is such a personal experience – who am I as an outsider to judge what is going on inside someone else’s body? Bill’s extensive research (which won him an award at the conference) has shown amongst others that vital signs have no correlation to pain and that females are less likely to receive pain relief. Personally I am still a little sceptical in regards to some of the findings – probably warranting a dedicated blogpost.
  • “Perceptions of clinical leadership in St John Ambulance Service WA: A research report” by Joseph Cuthbertson. A report on Paramedics preferences and reactions to clinical governance and leadership by Clinical Support Paramedics. Interesting from a leadership perspective because Western Australian does not have a tiered response system, every out of hospital emergency care provider is a paramedic (or student paramedic). Clinical Support Paramedics have a supportive role only, and do not have additional skills. Findings were that Paramedics wanted leadership and guidance from Clinical Support Paramedics who were confident, had experience, extensive background knowledge and patience.
  • By now my presentation was quickly approaching, so I clinked out of the buzz and retreated for a little last minute preparation. I’ll give you a more detailed version of my presentation in a dedicated post (hey, I have to give myself the special treatment somewhere!). Meanwhile, I had some spies scattered around reporting some interesting findings:
  • “Can relief from chest pain with nitrates inform a clinical decision?” by Laura Roberts. Studies have shown that you may as well flip a coin. That right, a complete 50/50 chance that the chest pain is of cardiac origin if it is relieved nitrates. Good knowledge to have in the back of your mind next time you respond to a chest pain call.
  • “Paramedic Response to Suicide Bombings: Learning form the Israeli Experience” by Christopher Foerster. Do you know how long it takes for an Israeli bus service to take up normal service after a bomb attack? 90 minutes. Pretty clued in, unfortunately the have had a fair bit of experience in these things…
  • “Occupational risks on undergraduate paramedic students in clinical placements” by Tegwyn Bath. The lecture prior to mine, but I still managed to soak up a little information as how to minimise risks for potential future students that may be riding with me.
  • “Recent Australasian Disasters – Fire, Cyclones, Earthquakes” by Paul Holman, Neil Noble and Major Brendan Wood. The closing talk of the day, showing the efforts and effects of the bush fires in Victoria, cyclone Yasi in Queensland and the Christchurch earthquakes. A little more on that in the next post though!

Paramedics Australasia Conference #2

An evening with a view:

Source: http://en.wikipedia.org/wiki/Darling_Harbour,_New_South_Wales

 

 

And an apparent poor choice of drinks which tempted my companions to register me for some gender realignment…ladybeer and cocktails.

They didn’t serve Bananenweizen (wheat beer with banana juice) like that when I lived in Germany…honest!

 

– ~ –

 

Day two in Sydney started off early, heading in to the city for the pre conference workshops “EMS Writing for Publication” and “EMS Reaearch Workshop. These two half day courses booked out quickly; I got in early and secured myself a place. Discussed were

  • “Writing Papers”. A introduction and general approach to how, what and why questions of research publication.
  • “Developing a research question and searching the literature”. Self explanatory really.
  • “Research Protocol and Ethics Submission”. Basically the frameworks, rules and regulations behind any research, giving it some structure and making sure that reasearch does not head down the path it took during the second world war under Josef Mengele.
  •  “What should we Research in Prehospital Care”. Well…what should we research then? Good question, with a rather simple and straightforward answer: Everything! Out of hospital care has only just woken up to the calls of evidence based practice – so much of our daily practice is based upon ancient dogma with no scientific basis. The take home message was: pick a page from your guidelines or protocols, and research their evidence base – more likely than not there will be insufficient evidence for a majority of them (have a read of RogueMedics blog for an idea what I mean). From there on it’s easy: pick a topic of interest, and come up with some research which will then support or refute current practice.
  • “Study Design”. Explanations of different evidence levels and study designs (cohort study, meta analysis etc).
  • “Statistics made easy”. Phew – 40 minutes of statistics at the end of the day were tough, but it actually made sense. Some good advice was given how to present your data in a positive light, for example using the median for response times – using the mean or mode would likely reflect bad on the times. Good to know these things when reading research/reports. ‘Don’t trust any statistic you haven’t skewed yourself’, as they say!

As complicated, academic and offputting the above paragraphs may be – once you sit down and let people in the know explain these things to you, it all makes perfect sense, and I would highly recommend considering the research pathway for anyone even remotely interested. The profession needs it, and your career and practice will only benefit. It has helped me to get on track for heading in the direction of research path. But more on research later, let’s stick with the chronological order.

My colleague went to the other workshop, the two day simulation workshop.  He reported back as it being a great part of the conference, both from a networking and a learning point of view. Topics covered included:

  • The state of clinical simulations: Simulations are becoming increasingly important in clinical teaching, one major factor being the limited quality practical placements available for students today. As many of you I’m sure have experienced, placement time is never long enough, and once you get there, you often stand around until your feet hurt.
  • The research and evidence base behind it.
  • How to structure clinical simulations.
  • How to run clinical simulations.
  • How to give feedback: Another point worth highlighting – the simulation must be seen in its entirety for maximum learning efficiency; from thinking about what may face the student, to doing the simulation, debriefing after the simulation and finally reflecting about the simulation – all crucial steps to assure the highest learning experience is taken from the simulation.

 

The evening was occupied with the pre conference drinks: networking, recognising old faces, meeting new faces, and finally turning some virtual twitter and email virtual acquaintances in to real in the flesh meetings.

Paramedics Australasia Conference #1

I recently returned from the Paramedics Australasia Conference in Sydney. Six days of travel, breaking away from the daily routine, plunging myself in to a large metropolis. But, most importantly, being amongst the brightest and most enthusiastic bunch of paramedics and paramedic-associated people nationally with some great international guests.

Day one in Sydney was a gentle awakening on a beautiful morning – ideal for a run around the harbour.

After catching up with some friends for lunch (good burritos, but nothing compared to the San Francisco one I had with @setla!), I caught up with an long-time paramedic friend, who has always been very supportive of me, and actually brought me to the world of international paramedical travels – he has worked in six services in four countries himself, not to mention the many more he has visited along the way.

One interesting topic we came on to was that of the paramedic profession, the perception of the public, and media. As anybody who has worked out on the road for more than a couple of weeks quickly comes to realise, the public’s opinion of our role, and the actual role we have in healthcare differs vastly. Two things of interest we discussed:

1. Communication between the people and the service:

  • Some people expect and demand an instant response. Like any other service, how about giving estimated arrival times, not only “the paramedics have been dispatched, and are en route to you” for urgent jobs, but also “We currently have a high workload, and due to the nature of the call, you have been assigned a low priority call. It could take up to [x] minutes until a paramedic can attend”.
  • People often call us for an emergency because they overreacted in the initial situation. Recent trials in different services have ‘introduced’ the question of “did you regret calling an ambulance?”, both for calltakers and on road paramedics. Additionally, the calltakers let the callers know that they can be called back if they want to cancel the paramedic response.

2. Communication between the people and the media:

  • Where does the public get a vast majority of their education from? The media. We should use this vehicle much more extensively to get our cause across to the public. Keep the TV shows, but have paramedic consultants and continuous paramedic input – the underlying message is important. Tell Joe Blow on the street what we can do, but also what we [i]can’t[i].  Inject some more realism.

I’m sure there is already a beginning of this out there, but it needs significant ramping up.

We need people with contacts within the media, who are willing to push our cause.

Know anyone?

I’m back!

Weeks of grinding through my last days of paramedic school, polishing up knowledge and skills.

Days of recuperation, relaxation.

Days of preparation.

Hours of dedication for inspiration.

Minutes of realisation.

Seconds of significance.