Month: March 2012

Emergency Siblings

Paramedic services should take a look at their emergency service siblings.

For example our older brother, the police. We do not see them sit at their police station until a crime happens – they actively patrol their area, their presence deterring crime and assuring citizens, their interactions with the public via stalls, info days, brochures and exhibitions informing the population on the prevention of crime.

Whereas we sit and wait for emergencies to happen. Isn’t it time that Paramedic Services integrate themselves in to the health system tightly, and evolve from passive response to (pro)active engagement within the community?

Approaching the shrine of evidence

or: I’ve come a fair distance, but have a long way to go.

Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe.

I recently embarked on postgraduate studies. My thirst for knowledge needed quenching, and my post-graduation emptiness needed filling; I was bored and suffering intellectual directionless. These issues have been rectified with a quite interesting Postgraduate Certificate in EMS leadership and Management.

But back to topic: I remember my first dabbles amongst paramedics…the spoken word of these people surrounding me was at first unintelligible blabber of latin and greek derived technical teminology, but with time and a dictionary, I cut through most of that. I had a basic understanding, and I was proud of myself.

Then came basic skills and principles of paramedicine: I was told about these many things that paramedics do, and I took them in as “that’s what paramedics do”. The occasional question was usually answered with some scientific based background knowledge that I did not possess, but sounded more than plausible.

In my mind, I could picture the shrine of evidence.

Then I got a copy of some clinical guidelines. Thoughts similar to “They must be right, the big people on the ambulance follow them, and I’m sure a lot of time and effort went in to writing them” went through my head.

From a distance, I could see the shrine of evidence.

Then I started studying paramedicine. I entered the beautiful world of evidence based practice. “It’s in a scientific journal, it must be right! They’re scientists after all!”. And along came large Randomized Control Trials. “The peak of trials! Truth! TRUTH!”

The shrine of evidence began to glisten. Polished marbled with golden words in capital letters sparkled from it. a truly majestic and intimidating sight. Upon it written in bold letter:

“Science is evidence is truth.”

Still not completely confident with the world though, more background knowledge on this whole topic was needed, and which is why I did not adopt the above statement.

I want to get closer to the shrine, but my sunglasses aren’t dark enough to ward off the sparkling and shining.

Then my lecturer recommended to read this.

Clouds pull up. The shrine has some ugly cracks in the foundation, and…wow, part of it is built on rotten wooden stilts!

A great read from “The New Yorker” Magazine, by Jonah Lehrer (December 13, 2010).

Read, ponder, and rethink your worlds. After all, we’re all only human.

Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe.

Target 3000 – Professional Registration for Australian Paramedics

PTWANG!!!

The arrow hits the target. But how accurate is the archer? How do we know his skills are up to date? Does he know what he is doing? Is he an archer at all?

And what am I on about?

Paramedic Registration developments are entering a hot phase in Australia – consultation exercises will be beginning soon.

Does this affect me?

As a Paramedic in Australia – YES! The title ‘Paramedic’ is not protected, anyone can call themselved a paramedic. Heck, I even saw an ad for a “Paramedic Skin Care Specialist” in the paper last year!

As a resident in Australia – YES! Registration will help standardise and raise the level of care brought to you should you ever require a paramedic.

Anyone else – YES! Join and help the profession forward. You can tell us about your own registration experiences, knowledge, pitfalls etc; we want the best system in place here in the land of Down Under.

And what should I do?

  • Contact Paramedics Australasia’s policy advisor Ray Bange at ray@bange.net.au to be kept up to date with all things registration
  • Visit the PA website www.paramedics.org.au/registration and read the registration documents
  • On Twitter, follow #ParamedicReg
  • Participate in all future submissions when they are released shortly
  • Talk to other paramedics in your workplace and be prepared for the registration debate!

“One small step for a paramedic, one giant leap for the profession”

 

In the beginning…

…there was light.

ambulance

Flashing light to be precise. From an age as early as three I can remember watching flashing lights with absolute fascination. Blue, red, white, yellow, in any flash pattern – I stared at them as in a trance.

My interest then expanded to the actual vehicles these lights were mounted on, particularly (surprise…) emergency vehicles. Big, important and colourful.

Following soon after was the interest in what was in these vehicles. Fire trucks, with their big car door munching scissors. Police cars with all their law enforcement and traffic regulation gear (more lights!). Ambulances with their multitude of bandages and other stuff I had no idea about. But the vehicles as such with their lights were still the utmost of beauty to my eyes (as you may gather, this was quite early on and I hadn’t discovered girls yet).

Then came more curiosity of the insides: who actually sits inside them and does all the work? Who are these people? Why do they do what they do? What do they experience, and what gear do they play with?

There was only one way to find out…fast forward a few years and I think I have been able to answer all those questions I once posed to myself.

But every now and again when I catch myself at a scene for a split second, staring at the van, still fascinated by the lights.

And the boy inside me thinks: “I wonder what is inside there?”

Act F.A.S.T.

I came across an interesting fact recently, a fact worth sharing:

In an ischaemic stroke, cell death occurs at a rate of 1.9 million neurons an hour. This is the equivalent of the patient ageing 3.1 weeks every minute (1)

Makes you reconsider what is actually going on in the brain. For successful treatment and a (near) full recovery, time is of the essence…as the best anti-ageing potion.

There is a definitive time bracket for the treatment of ischaemic strokes with tPA (Tissue Plasminogen Activator) – where I live the cut of time is 4.5 hours from symptom onset (2)

Many stroke symptoms are recognise too late – remember, time is brain, and the public need to be aware of common stroke symptoms. The F.A.S.T. mnemonic has been an initiative by the stroke foundation here in Australia:

http://www.strokefoundation.com.au/signs-of-stroke-FAST

But we as Paramedics can also have a positive impact on suspected stroke victims – by recognising the signs, transporting the patient to an appropriate facility and pre-notifying the staff of our arrival (3).

 

What are your stroke guidelines and procedures?

 

References:

1 Saver, J. Time is Brain – Quantified Stroke 2006;37:263-6 via Michael Moldoveanu “Delays in Thrombolysis for Ischaemic Stroke Patient: Implications for Paramedic Care” Response Spring 2011 (Volume 38 No. 3), Paramedics Australasia.

2 p.27, Model of Stroke Care 2012, WA Dept. of Health. http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Stroke_Model_of_Care.pdf

3 p.24 Model of Stroke Care 2012, WA Dept. of Health. http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Stroke_Model_of_Care.pdf

Equal numbers of neuronal and nonneuronal cells make the human brain an isometrically scaled-up primate brain

http://onlinelibrary.wiley.com/doi/10.1002/cne.21974/abstract;jsessionid=B56BA8474F1D8E28F05588AFC5CF3837.d01t01

Neurons, Synapses, Action Potentials, and Neurotransmission  http://www.mind.ilstu.edu/curriculum/neurons_intro/neurons_intro.php

 

P.S.:

If you are wondering how many neurons the human brain is actually made up of, estimates range from approximate 86 billion (4) to 200 billion (5). So in terms of percentage of neurons actually dying an hour, this equates to roughly 0.0000221% to 0.0000095%. Which would translate in to waiting approximately 45 249 to 105 263 hours (1885 days or over 5 years to 4385 days or over 12 years) for one percent of the brain to have died. Multiplied by 3.1 weeks a minute…oh sod off, I can’t be bothered. Do it yourself 🙂

 

 

 

 

Stones

“Any other medical history, Dorothy?” I ask our patient, trying to get the bigger picture of what may be going on.

“Stones! I have Stones!” She replies.

“Where are they?” I ask, and after a blank look I give her a hint: “Gallstones maybe, or in the kidney?”

“Stones, I have Stones! Doctor says they wander, move around. Says I have Stones!”. This is getting nowhere fast, so I politely skip to the next question.

An uneventful transfer later, we reach hospital. Of course the triage nurse would like to know about these wandering Stones.

“Hi Dorothy, I’m Claire, one of the nurses at the hospital here. The Paramedics tell me you have Stones – where are they?”

“Stones, I have Stones!” Unsurprisingly, we’re getting nowhere fast again. “I have Stones! Doctor says they move. I have Stones!”

To cut things short, I interject: “I believe they are gallstones, but they have a holiday house in the kidneys. They’re the Rolling Stones – thats what rockstars do.”