Month: December 2012

Go!

“Travel is fatal to prejudice, bigotry and narrow-mindedness and many of our people need it sorely on these accounts. Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one’s lifetime.”

 

– Mark Twain

2 1/2 hours

My phone rings. I answer.

Receptionist: Hello, Mister Bach?

Me: Yes, speaking.

Receptionist: Your blood test results are back, and the doctor wants to speak to you about them. We’ve just had a cancellation, are you available this afternoon for an appointment?

Me: Yes…

OK, rewind: After being discharged from hospital, the ENT specialist told me to get a follow up blood test in a weeks time for a liver function test with my GP.

GP appointment made, phlebotomy paperwork acquired, told to make an appointment one week after the blood test.

Not a problem – although being slightly needle phobic, I let my antecubital fossa be attacked by the phlebotomist the next day – needle in, blood out, thank you very much. Results will be sent to the doctors surgery in a weeks time.

Then the above mentioned phone call. This wasn’t “call me in a weeks time”. No, this was “the doctor would like to discuss the your results with you, come in two hours time”.

The department store I was in went a bit fuzzy. Normally being fairly level-headed, this disrupted my world. What is there to discuss? Something must have gone wrong…maybe my liver suffered more than expected, I developed hepatitis, I acquired some infection or disease from hospital, I will need a liver transplant, all my future plans are going down the drain. The christmas shopping I just finished half an hour ago? Meaningless. “Here, have a sloppily wrapped present, and by the way: I’m not going to survive next year.”

The following two and a half hours were torturous. The trip on the tube home was the longest ever – reading the paper was pointless, playing Sudoku produced a mass of errors, sitting looking in to space just made my mind wander to even more horror scenarios, and playing out different scenes how to tell friends and family. And clutching at straws, maybe the GP just wants to tell me not to drink alcohol over the Christmas period to give my liver a rest…but then again, it could be liver failure.

I arrive at the GP surgery. I wait. As always, the GP is running late. Half an hour later, it’s my turn. I get up, walk towards the room, take a deep breath, open the door, and sit down in front of the Doctor.

“Hello, how are you going?” he asks me cheerily. OK, not what I expected. I mumble that I’m alright, and ask him about my results. “Yes, your results are in. Your liver function test has come back fine, and all your other values are within normal limits. You’re feeling better, Yes? No coughing, or other symptoms? Great! You can get back in to your sports routine when you feel ready, too.”

Phew. That was it? That bloody receptionist. My bloody imagination. Damn circumstances. Probably lost a few years because of that…not a nice experience. At all.

After telling the GP of the doomsday scenarios that were playing in my mind, we had a bit of a chuckle (I had to let my relief out some how!), chatted for a few minutes, and wished each others merry christmas and a happy new year.

You may smirk reading the above, you may shake your head, but believe me, it wasn’t pleasant. But it did teach me a lesson, shoving me back in to place, with the realisation thrust upon me: Cherish your health, your life, your loved ones.

It could change in the blink of an eye.

Toronto

June 2011

From New York Air Canada took me up to Toronto. I was looking forward to visiting Canadia; I had a preconcieved notion of something excellent, and was eager to find out if my expectations would be met.

First impressions were good. A big airport leading in to a big city, and everything seemed a bit more…normal. This was a feeling I had throughout my time in Canada, and has been echoed by other people I talked to that have been there – Canadians are just that bit more down to earth than their border-buddies. No disrespect at all to the citizens of the USA (they looked after me well), but when you look around, talk to people and soak up the atmosphere…there is a certain je ne sais quoi that made me little more comfortable. Everything doesn’t have to be the biggest – including cars and people. Not everything has to be AWESOME and AMAZING. I can’t put my finger on it, but I do like Canada and Canadians (well, Toronto, unfortunately I didn’t get round to seeing much else).

Bit of a let down when it came to experiencing their Paramedic Services. I had organised (in advance) for a ride along with Toronto EMS, including an application letter to the Chief of EMS with a recommendation from my university Professor and supporting letter from my employer (all required by Toronto EMS). All I needed was a P95 mask fitting prior to actually heading out. I arrived Wednesday, got hold of Toronto EMS on Thursday, Friday was a public holiday, mask fitting aren’t done on weekends, and I was leaving Monday.

So no shift.

Slightly annoying, luckily though through some friends I was able to catch up with a Paramedic from the Peel Region Paramedic Services and compare our services over a cuppa. Unfortunately I forgot my notepad, so all I can tell you is that it seems to be a great service, with decent shifts, pay, guidelines, trials and general training. One thing the Canadians haven’t picked up on yet is tertiary education for paramedics – one area where Australia, the UK and South Africa (for their advanced level practitioners) are ahead.

And because I’m sure you don’t want to hear about the occasional boozy night in Toronto or the angry woman in the recorded announcement on the Toronto Subway, I’ll leave you with some impressions of Toronto and Niagara Falls:

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A Toronto Tram in front of the architecturally excellent Toronto Art Museum

 

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An ORNGE (their spelling mistake, not mine) helicopter landing at Toronto’s “Sick Kids” hospital (no imagination whatsoever).

 

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A Seattle fire truck on the streets of Toronto? Just another film set!

 

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Niagara Falls #1

 

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Niagara Falls #2

 

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Niagara Falls #3, the mist

 

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A tow truck towing a tow truck towing a car. Brilliant!

NYC: Aftermath

June 2011

Image via Wikimedia Commons

In one word: Wow.

I was really looking forward to visiting New York City, and I was not disappointed. The size, the vibrancy, just everything is amazing. Being a tourist in Manhattan is excellent on its own, but to see the streets of Brooklyn and Queens from a paramedics perspective is the ultimate sightseeing – going inside people homes, seeing how they live, being able to help out, and getting a proper tour of the streets with like minded people – other paramedics.

I spent five days on my own in NYC, which was my dedicated Paramedic exploration time. Later that holiday Sophie joined me (I had eight weeks off, she only had four), and we visited NYC together. We met up and went out with both the Paramedics from my last shift, Gozo and Drew, which allowed for a bit more of a social exchange in an excellent culinary setting – one night we stuffed ourselves with southern food, another night Gozo ‘kidnapped’ us to Spanish Queens: everything was in Spanish, and we couldn’t understand a word that was written around me. Sophie and I were the only white people around. I would have felt seriously lost, out of place, and probably a little uncomfortable if Gozo wasn’t around, but he navigated us to a locals restaurant that luckily had many pictures on the menu, which made decisions a little easier. Needless to say, the three of us ordered for about five people, which cost for what I thought would have been appropriate for two people, and ended up paying for nothing.

And thats it. Say what you want about Americans but they are such a friendly and hospitable bunch. I couldn’t have paid the ransom money for my own mum it seems, I was “their guest” and any attempts to foot the bill taken with a smile, a dirty look and the bill was jokingly yet violently pulled out of my reach.

I am very much deep in your debt for your hospitality and making us feel right at ease in your great city. There may be some things that I fundamentally cannot agree with (your healthcare system is screwed in my opinion), but as a bunch of people, you made me feel very welcome. And for that, I am very grateful.

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NYC: Caribbean Care part II

June 2011…a continuation from NYC: Caribbean Care part I

So, this shift we would be doubling up – two qualified NYC Paramedics, two student Paramedics; one from New York, the other from Perth, Western Australia (me, in case you’ve missed the point). Me, the one wearing green with reflective bits. Working for St John Ambulance. Which is funny, because the other student is doing his Paramedic course through St John College. Coincidences!

Doubling turned out to be a great thing. For the whole shift, we now had an even number of people on the ambulance, no third wheel feelings. Whilst driving, the two paramedics sat up front, and the two students in the back. I could compare the courses we have been going through, with plenty of time. Education levels, content, delivery of material etc. were all discussed. On the job, he attended, one paramedic always at hand to give help out if needed (which wasn’t), the other paramedic grabbing the stretcher if needed. And I hovered in between, but never felt spare. Jobs were discussed together, food was eaten together, I learnt a whole lot. Driving to hospital space was tight in the back and if the patient wasn’t too sick, I hopped up in the front and chatted with the driver medic. The shift flew by, and we all had a ball of a time.

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Ready to go!

So, what did we do all day? We were en route (“enn rauwt” as opposed to “on root”) to a standby when we get diverted code three (lights and sirens) to a fifty something year old female feeling faint with leg pain. Woo woo, flash flash, woo woo woo woooooo…in the US, especially in NYC, paramedics love to play around with their sirens. Little woop here, longer wail there, chuck in some yelp and phaser, ending with a blast from the air horn. It’s their culture I guess, though sometimes I wish they’d just leave the bloody thing on. They’re a playful bunch.

We fight our way through traffic, our red and white beacons ricocheting off street signs. I miss the blue of our Aussie ambulances – a colour only recently allowed on ambulances in NYC, and even then only facing the rear. This is explained by the fundamental difference in retinal physiology between UK and NYC citizens – the cone cells are structurally completely different between these two species – the NYC kind would be mesmerised and perplexed by forward facing blue lights, hence the laws to prevent such horrors. The UK specimens would equally be in deep strife, but in a different way. Here, red flashing lights are only allowed to be rear-facing. Imagine how the British would be confused if this were not regulated by the law. This, I presume, is also the reason for strict border controls, limiting the intermingling of these fragile species in unfamiliar environments.

Anyway, back to our call. We turn on to our destination street, and immediately know where the house is – there’s a big red fire truck with fifty million flashing lights parked right outside. FDNY (pronounced Fidney, rhyming with my hometown Sydney) respond to all emergency medical call outs as first responders – helpful in some situations, overkill in others. We crowd inside the little house, six firemen, four paramedics, and begin history taking and treatment. It is quickly assessed that the Firefighters are superfluous on this call, and, after answering a few questions why the heck I am running around like an employee from the sanitation department, they are about to leave…when two police officers poke their heads round the doors. Apparently NYPD are also dispatched to every emergency call, slightly over the top in my humble opinion. They know they are not needed, but we thank them anyway and they head off, probably to the nearby donut shop.

I am amazed at the amount of resources thrown at this job. Three vehicles on a lights and sirens response, ten professionals from three different services. America is the land of plenty, think big, but it begs the questions “is it worth it?” and “can they afford it?”

I’ll let you discuss and decide that one.

Back to our patient, we treat, transport and joke, all the way to hospital. Our patient is stable, her spirits are high. Then we arriving at the hospital – a bit of an eye opener. It’s bursting at the seams it seems, and it’s only a tuesday afternoon. Three people to a cubicle, nil privacy. If you were to draw the curtains, they would drape over the person lying on the centre bed. This isn’t a quite place. Staff scurrying around, some barking orders. Some guy is screaming for food. I position myself in a corner for a better overview of the department, and realise that this “some guys” deep coarse voice actually originates from some haggard old woman with an haggard old face on a haggard old body. Rough times indeed.

In the other corner, someone else starts shouting. A trauma call is brought in by an EMT crew (trauma is a BLS call in New York City, unless it is obvious that ALS intervention is needed and subsequently requested). We are quickly triaged briefly, vital signs are taken by EMS in hospital. Pt is loaded on to a bed in the exam room, examined, and we leave.

Outside, a FDNY EMS lieutenant is having a discussion with paramedics about using the scoop stretcher as an immobilisation device. He skims around the point, not accepting it for such a use; the paramedics insisting that it can be used (we certainly did in Western Australia…we didn’t even have spineboards until the beginning of 2011!). His way or the highway. We don’t bother to get involved, and choose the highway, outta here for more street action.

Mind you, on the subject of spinal immobilisation (or attempted stabilisation), the 15 minutes I spent at hospital was quite an eye opener: three more people are brought in to the ER strapped on to spineboards. And there are more lining up outside. Overkill.

It’s time for restocking the van as well as our stomachs. We head to a German Deli, where I grab the highly recommended roast beef roll. Well, a small to medium sized roll with a ton of roast beef stuffed inside.

We have enough time to eat without having to wolve it down – then right on the last bite, back to the truck for another call. It is now pouring outside.

We pull up outside the apartment building. A family get together, they have come from everywhere: Puerto rico, hawaii, and nana wants to fly back home tomorrow…well probably not, as she has a chest infection. Treat, transport, joke – a good routine. At hospital, we are told that our last patient has been discharged with nothing serious to report.

We make ourselves clear for another job. The radio crackles to life…and…standby. We park up on a nearby corner, and let our bellies digest teh roast beef a little more. Andrew (the NYC student) and I compare our education programmes a little more. He has gone through EMT school for three months, graduated as a basic, then decided to go to paramedic school. Generally this is one year full time, and costs around 9000 US$. This is then followed by taking the State and National Registry tests to become a qualified Paramedic. Quite compressed compared to what I’m going through (three years university plus three years on road experience).

The day wears on…do I want to go home, I am asked? No brainer there: “Hell no, I’m going to stay right until the end! Having too much of a good time!”

Waiting is tough and uses up a lit of energy. It’s food time again, so the collective agreement. Spanish pork with rice, we have to show you this stuff they insist.

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Food. A lot of food. Too much food. Yummy food.

Full to the brim. Cannot walk. Roll to the ambulance. I want to explode.

The last job of the day comes in (burp, ooh my yummy tummy hurts), a girl in her twenties complaining of a sore throat. Yup, gotta end the shift on a high note – ALS, lights and sirens to our patient with a cold…and a bit of attitude as well. Apparently she has been prescribed penicillin…but she has ben taking it now for six hours, and its not working. Gozo explains how penicillin works, but she’s having none of that, and wants to go to hospital. She happily walks to the van.

I pop myself in the front, and chat to Drew, who has been a paramedic for five years. He is studying psychology; his long term aim to get out of EMS, as he can’t see EMS providing a long term future for himself. Hoping to progress on to a Masters and possibly an PhD, things he laments that are missing in the world of Paramedicine…until I explain how things work in Australia, how the majority of education is university based, how you can get in to research, you don’t necessarily have to work for a state/county/municipal paramedic service; you can end up working/teaching at a university…or so much more. His jaw nearly hit the floor, and I may have detected a bit of envy oozing out of his pores.

At hospital, we bump in to relatives of our chest infection nanna, who confirm the paramedics provisional Dx of a chest infection. They thank us again for helping out, and we say our goodbyes.

Then a commotion from a few beds down the aisle – a loud moan, a shriek of a relative, followed by much rattling, wailing and high pitched screaming.

A patient is having a tonic-clonic seizure in his hospital bed, together with a screaming and freaked out relative at his bedside, having no idea what is happening. Hospital staff are extremely slow to respond, but my trusted paramedic colleagues are quick to take action, positioning the patent on their side, trying to calm the relative down, explaining what is happening. A junior doctor arrives after a minute, and is completely flustered. The nurses aren’t much better. Gozo orders the doc to get some Midazolam for this patient, all whilst continually talking to the relative, explaining what is happening (“no, the devil has not taken possession of you loved one”, he explains in Spanish), and occasionally interjecting with some paramedic wisdom directed and Andrew and myself. Andrew is especially interested and excited, as he has never seen a seizure before – and we were just discussing different seizure presentations and treatments earlier on in the shift. And not playing my own interest down, this was only the second seizure I witnessed, and in quite a different environment I’d expected – an overcrowded emergency room in NYC.

The seizure subsides, the situation is under control, and we stroll back to the Ambulance. But what do I spot there? As we leave, we walk past some EMTs who have come rom La Guardia Airport – and they don’t look like regular EMTs. Probably because of the gun and cuffs next to their penlight and trauma shears on their belts. They are police officers from the Port Authority Police. Their uniforms have EMT and Police written all over them. Police officers in EMS duty. Not sure If i agree with the concept, but there you go. They’re a BLS only system, ALS backup is called from NYC EMS.

Outside, another interesting sight: a FDNY ambulance, but this is a HazTac/Rescue unit…cool. These are the guys that go in with the dirty stuff, CBRN, confined space rescue etc – similar what the UK HART units do.

Image from Wikimedia Commons

One of the FDNY Haz-Tac EMTs spots us, a big brawny bloke with a crew cut, and walks towards us with a quizzical look on his face (the look of the day, it seems):

“Two questions: 1) are you gay, and 2) can you keep a secret? He winks at me with a dirty smile, slaps me on the shoulder, and I explain myself (yet again) why I look like I work for the sanitation department. He gives us a bit of an insight to the ins and outs of the HazTac units.

And thats it. Not many calls, no life or death situations, but what an informative and exciting day! We finish out shift half an hour late, but no-one really cares, we all enjoyed ourselves. We drive a few minutes back to the depot, clean and restock the van with the other crew that is taking it over for the rest of the night. Drew is on for a double shift, and so keeps the keys of the van.

Gozo looks at his watch: “I was told you’re taking the subway home. Nope. No way you’re taking the subway home, it’s hell dodgy at this time of night! Wait for me, I just need to finish this paperwork and I’ll drive you home. No ifs or buts.”

Can’t argue with that!

NYC: Caribbean Care, part I

June 2011

 

[general chatter in the background, footsteps, doors opening and closing]

*cling*

*clink cling*

*tap tap tap*…pause…*tap tap tap tap, tap tap*

*beep beep*

*beep beep*

Such would have been the backdrop standing next to me at the payphone of the hostel I was staying in. I’m following up from the previous nights offer of getting out on shift with Paramedics in the New York City borough of Queens, having dialled Barry’s number. After a short wait my call is answered.

“Hello it’s Barry” it comes in a thick New York accent, reminding me more of “The Godfather” than “The Paramedic”. It seems that I am on speakerphone, and that he is driving. I imagine the telephone on the other side of the line set in a massive black Cadillac being driven though the streets of Manhattan, tommy gun on the passenger seat and a dead body in the boot. And the Fedora casually slanted on his head in true gangster fashion. I give myself a mental kick to focus back on the task at hand.

“Hey Barry, Flo here – the Paramedic from Australia. We met last night at the REMSCO dinner.”

“Yeah, how ya doin’ ?. You got something to write? June 32nd (obviously that’s not what he said, I’m just de-identifying the date for the blog), you come to our Hospital in Queens, and we’ll get you on a truck!”

Times and directions were exchanged. I was being picked up from the subway station. The shift was sorted. Brilliant. Gold Class service right there.

On the day, I arrive in Queens, find the hospital (no problems due to the easy directions) and call call Barry to let him know I have arrived. He’ll be there in ten minutes, I should have a look around in the meantime – something I don’t need to be told twice. There were a few ambulances parked near the Emergency Room entrance, so I went to have a sticky beak at the closest one, and take a picture whilst I was awaiting my chauffeur.

“Hey, you can’t take a picture of that without us!”

A loud female voice carried from the next ambulance parked just down the road, slightly bossy but with a distinctive giggle in there.

The three EMTs are just restocking their vehicle a few metres down the road, and are obviously not envious of the attention the other ambulance is getting. “Well, you better clean up the van and pose for the lens!” I reply, beginning to walk towards them. Apparently the girls didn’t quite anticipate this reaction, and looked rather startled. When you tell somebody to point their camera in your direction, you would never in a million years expect them to actually do just that, would you? Must be female logic…

Anyway, the three of them turned out to be bright and chirpy, with the startled face quickly turning in to a quizzical face, what I am doing here and what’s with the green trousers and the reflective stripe? Apparently, in NYC, green uniforms are associated with the sanitation department (some old medics will remember that NYC ambulance uniforms actually were green back 20+ years ago), but I was quick to take my jumper off and show my work shirt, revealing the (to Americans) foreign term “Ambulance Officer”. We all had a good chat, laughs; Discussions and comparisons followed, and a few minutes later i think we have three potential new visitors to Australia. Barry, the supervisor turns up, and sees me chatting away to to a bunch of his girls. He shakes his head with a grin.

We drive ten minutes down the road, talk about how things in NYC run, his history (active paramedic, paramedic and EMT instructor, his roles as supervisor). The station is again a large garage, parked full with about 10 ambulances, lockers, mechanical stands around, mess room adjacent. I am first introduced to the head of the service, we exchange a few introducturies and I quickly explain what I’m doing on this trip. No time for much more, I whizz off with Barry to the mess room, he has sorted out a crew that he wants to put me with, only the hand picked best guys for the Australian visitor apparently!

There are about ten EMTs and paramedics milling around the mess room, some on break, some ending their shift, some getting ready for their upcoming shift. Then I am privileged to one of the best introductions towards the staff:

“Everyone, i want you to welcome flobach – all the way from Australia! I met him at the REMSCO dinner the other night, a good guy, and I wanted to show him how we  do EMS in New York City (Yeah! show him the real NYC, people mutter, and nod their heads in a mix of love towards their home city and profession). I want you to look after him. Flobach will be going out with you, Drew and and Gozo. Your shift goes until 11pm – I want you to drop him off at the subway station, I don’t want him running around here on his own at night, do you hear? Take him right to the station, and look after him. Have fun guys!”

With that, he shakes my hand, gives me a smile, and leaves. None of this wandering in to foreign paramedic quarters, trying to explain to disinterested crews why you are giving up your spare time to do a shift. This was a smooth start!

With that introduction, I slot right in. The crews are interested about my background. We chat about Australia, their service, my trip, the lot. I feel more than welcome.

I show them pictures from Australia, and all of a sudden everybody wants to move there. Conveniently, I tell them, my service is just having a massive recruitment push…eyes light up…and I wonder if I should charge my employer commission for recruiting potential new employees. They like the idea how things in Aussie run. No calling for orders. The drug range is decent. The working conditions are great, leave, pay, vehicles, roads. A very attractive place indeed. Surgical cricothyroidotomy raises eyebrows. They may be getting ondansetron next year…I tell them to look forward to it:-)

Meanwhile, Gozo is twirling his neatly trimmed moustache, worried about the unilateral greying. I suggest colouring it in with a piece of charcoal a trick I learnt from my dad. He’ll give it a try, he reckons.

Finally, our truck arrives, after being held up on a late job for 45 minutes. A student on placement, Andrew, shows me around the truck, as he is attending today – the paramedics are really only there to help with extrication and make sure he is up to standards.

I need to briefly pop back in to the office to sign an indemnity form so I won’t sue them – fair enough – when one of the paramedics pokes his head around the office door and asks for Barry to come in to the mess room.

“Um, boss, student is out with us today, can’t really take flobach.”

“No way, he’s going out with you guys! He’s come all the way form Australia!”

“But student actually pays money (via his paramedic course) to come out on a shift…”

“But this guy has travelled all the way around the world from Australia!”

“Put him with the other crew”

“No”

Hmm…pensive silence.

“Can they both come out with us?”

“I guess so…nothing stopping you really!”

 

Stay tuned for part two…

Report, part 4

From Australia, where the last three reports have come from, let me whisk you away to Guatemala, one of the most violent countries in the world according to the BBC.

But on our way there, let’s stop via Cardiff, in Wales. There we will pick up Angie, our Paramedic, and transplant her from a relatively tame setting to the rough and ragged streets of South America.

I think she’s in for a bit of a shock.

You can read a bit more background information here from the BBC, or else jump right in to the show below.

[youtube http://www.youtube.com/watch?v=rORB6S2MwyU]
[youtube http://www.youtube.com/watch?v=BfX9h4fXZsc]
[youtube http://www.youtube.com/watch?v=ZgGgD9vJvyA]
[youtube http://www.youtube.com/watch?v=148OP328ASA]
[youtube http://www.youtube.com/watch?v=iDWoS379S-4]
[youtube http://www.youtube.com/watch?v=Sru2-7Rwhq4]

Who you gonna call?

My friend had a heart attack at a party we were at. We were all taken by surprise, and I dialled the paramedics as quickly as I could.

As his wife knelt by his side, she was frantically screaming

“How long is the bloody ambulance going to be!?”

“About twenty feet” is apparently not the answer she was looking for.

 

Moan and groan as much as you like – I had to laugh the first time I read this.

And now, before you strangle me because of my percieved bad sense of humour (you wouldn’t be the first one), hear me out. This has a serious twist to it.

What’s in a name?

A clear misunderstanding – the first person dials for medical assistance in the form of Paramedics, whilst the wife of the victim asks how long the vehicle will be.

Why?

Why is it so engrained in to the public mind that if you need medical assistance, you call for a big box on wheels with flashing lights and some bright paint splashed on the side.

If my house is being burgled, I don’t want a police car, I want police officers. If my garden is burning, I don’t want a fire truck, I want some firefighters. If my toilet is blocked, I don’t want a van with a tap and some tools in the back, I want a plumber. And so forth, I could carry on ad nauseum.

So why the fixation with our transportation device (which is in decline anyway, but Community Paramedicine, Paramedic Practitioners, treat and release is another story). Why the constant referral to our vehicle?

Any Paramedic is most likely to develop and burst an aneurysm very quickly if referred to as an “Ambulance Driver” all to often. We don’t like that. We do more than just drive the ambulance.

But no-one really bats an eyelid if the vehicle is called for assistance, without any proper regard to the professionals that actually staff the vehicle and perform the magic.

If you need medical assistance and call an ambulance, maybe the ambulance will help you get better. But since we don’t have vans that can drive autonomously, thats why we need “Ambulance Drivers’. They just drive the vehicle; they won’t attempt to help or heal you, the vehicle will do that. They just drive the ambulance.

Don’t believe me? Think I’m rabbiting on about nothing? Missing my point?

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At the Emergency Services Show 2012 (I wrote about it here and here) I came across many ambulances of all shapes and sizes. As you can see above, many things marked as an “Ambulance” had arms and legs, a torso, and a head on the top. But no flashing lights. Strange, since the Oxford Dictionary defines an ambulance as:

a vehicle equipped for taking sick or injured people to and from hospital, especially in emergencies

I doubt the bloke in the picture would really want to piggyback a sick or injured person all the way to hospital.

But the misnomers don’t stop there, oh no. What about “Ambulance Service”? Is this the local van dealership providing vehicles?

Here in the UK there is an organisation going by the name of NARU – the National Ambulance Resilience Unit. I suppose the splash very tough paint on the trucks, and maybe equip them with bulletproof tyres.

Then there is the AACE – the Association of Ambulance Chief Executives (also on twitter). When on shift, and I’m the clinically most senior person working, does that make me the Chief Executive on the Ambulance? What about when the ambulance is at the workshop? I take it the AACE are a bunch of people in charge of a lot of vans. Fleet managers I believe is what they call them.

Last but not least, the AACE have an “Ambulance Leadership Forum”. Sounds like an advanced driving course to me – how to lead my ambulance through heavy traffic, and around oddly placed cones on the ground.

I hope I have got my point across what we are not.

So then, if we aren’t a vehicle, what are we? Simple:

We are Paramedics.

We practice Paramedicine.

We study Paramedicine.

We (generally) work for Paramedic Services.

Canadians picked this up quickly (Ottawa Paramedic Services, Peel Regional Paramedic Services, to name a few). No matter what education, you are a Paramedic. Primary Care, Advanced Care, Critical Care…all just subdivisions: They are Paramedics. Some Australian states have picked it up in part (most notably New South Wales and Victoria).

I am aware of some of the legal minefields in different parts of the world (for example, the title “Paramedic” is reserved to those registered as a Paramedic in the UK, and anyone stating they are a paramedic without UK proper registration is committing an offence and can be prosecuted). But I will still refer to you all as Paramedics. You still practice Paramedicine.

Now its time for the rest of the world to wake up, and follow the naming guidelines from International Paramedic (I wrote about it earlier this year):

  • The Paramedic is the professional practitioner
  • Paramedic Service is the provider of emergency medical services staffed by paramedics; and
  • Paramedicine is the discipline and the area of medical study and knowledge.

What’s in a name? A whole lot. If we as a want to be taken seriously, we need to be referred to by our professional title. That doesn’t incorporate our vehicle.

It’s our profession.

I am a Paramedic.

Emergency Services Show 2012, part II

Whilst gear is cool, it’s the networking that adds the heart and soul to these events. Meeting a bunch of enthusiastic and like-minded people in a country far far (or not so far, depending on your definition) away from home was invigorating and exciting. I’d been in touch with a couple of people virtually but had never actually met them in person before – what a better event to change this?

The first day I met up with Matthew Harris who runs HarrisCPD – a great site (not only for UK Paramedics) to keep on top of the fast evolving field of paramedicine. We explored the halls together for the day, chatted about a few different ideas and thoughts about the current paramedic environment in the UK, and Matthew even managed to sneak me in to his live podcasting of the event! Listen to it here. It was great to have someone to wander around and chat with, gave the whole day a much more relaxed and friendly atmosphere.

Unfortunately Matthew could only come for the one day, but not to worry, there were still plenty of people and stands to visit, for example the College of Paramedics (read their review of the show here). I was also very excited to finally meet TJ (aka @meditude) in person, who then promptly ran away (maybe I should have combed my hair differently? Did I brush my teeth properly?). Alas, no, he was just off to give a lecture on Mental Health from a paramedics perspective, which brings us nicely to the Continuing Professional Development seminars:

Both the College of Paramedics and PhysioControl offered some very interesting (and well attended) CPD events both days. I attended the following (with some key points of interest)

  • Mental Health for Paramedic Professionals: Not much training is provided to deal with patient suffering with mental health issues. Yet it is estimated that 10-20% of all calls in the UK have a component of mental health. A novel idea was proposed by TJ, the presenter: Specialist Mental Health Paramedics. We already have Paramedic Practitioners, Critical Care Paramedics – why not specialise in Mental Health? Some rudimentary calculations and thoughts from yours truly: Critical Care Paramedics are sent to really sick patients, but the call volume equates to approximately 2-3% of all calls. Given that mental health takes up a much larger chunk of call volume – surely one could argue a decent case for the introduction of such specialists? I think a trial is needed.
  • Management of Minor Injuries: Presented by a long time Paramedic Practitioner (PP), an overview was given how PP’s have positively influenced healthcare in the UK. An interesting point made was to leave the patient with enough information if they are not conveyed to hospital – enter the Patient Information Leaflets (these are from the South West Ambulance Service). Great idea!
  • Emergency Childbirth: A situation I’ve been in a couple of times, and a situation I dread again, again and again. I just don’t like it…but that doesn’t help, I need to keep refreshing my mind just in case I come in to such a situation again. Initially the course was cancelled as the midwife couldn’t make it – but then luckily last minute a Paramedic turned up and volunteered to fill in, as she had been a midwife in her previous career. Thank you!
  • Dr Richar Lyon talked about Improving outcome from OHCA: The TOPCAT 2 project – the video is from Resuscitation 2012 on Vimeo. Watch the video, it’s very interesting what one can achieve by analysing the data, getting a structure and education framework in place to then achieve some really good improved results.
  • Mark Whitbread, Consultant Paramedic with the London Ambulance Service (LAS), talked about 12 lead ECGs. Not my strongpoint, but the way he explained it de-mystified the whole approach nearly instantaneously. Impressive. Mark is also the man behind implementing true STEMI care within the LAS, a short video can be seen here.

Emergency Services Show 2012, part I

Well, I was going to present you with these three posts shortly after the actual event, but instead found myself in hospital. Please send your disappointments and hatemail to Mr In.fectious Mononucleosis, 16 Swollen Tonsil Street, Throatland.

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Last Wednesday and Thursday (22nd and 23rd of November 2012) I went to the annual Emergency Services Show in Coventry, West Midlands, UK.

Impressions as a first time visitor? Quite large, mainly geared towards fire and rescue services (a lot of big red trucks and fire retardant clothing, but together with law enforcement products there was a not insignificant amount of Paramedic and healthcare-related stands.

Here are some interesting products I came across. For the record: I don’t take any money from anyone, everything showcased here are goods and inventions that I found interesting, listed in alphabetical order:

  • The Corpuls 3 monitor sports an interesting concept: it can be broken up in to three parts, namely the monitor, the cable module and the defib module – all linked via Bluetooth. Apparently great when carrying patients down stairs, I’d want to try the system out for myself. Corpuls isn’t a well known brand in the English speaking world (yet?), but is widely established in the German part of the world – the current ambulances in Frankfurt/Main (where I started my EMS experience as a volunteer) has them, and seem to be happy with them.
  • Jones & Bartlett Learning: A new “Emergency Care in the Streets” from Nancy Caroline is supposed to come out next year. They have also taken over the publishing for the UK national JRCALC guidelines, due to come out February 2013. A variety of interesting books, presented with smile. Remember, College of Paramedics members receive discounts!
  • Prometheus Medical Ltd has a new SPHERe (Specialist Pre-Hospital Emergency Resuscitation Course) on offer, based on structured information gained whilst analysing, structuring and vastly improving cardiac arrest outcome in the Edinburgh/Scotland area (more on this on the CPD post shortly)
  • The UK Home Office Centre for Applied Science and Technology (CAST) had a stand too – interesting to know how the government is involved (not having lived in the UK before), and how they help out the emergency Services. For example, it was explained to me all emergency vehicles are checked by them for electrical interference (radios etc). There’s much more to it though, check out their website.

Unfortunately, the stands of JESIP (Joint Emergency Services Interoperability Programme), and the AACE (Association of Ambulance Chief Executives) were unmanned when I walked past. I looked around for anyone in the know, but no show. Disappointing, but there were some brochures with weblinks for more info. Remember, I’m new to the UK, a show like this is a great way to get to know how everything works, and what governing and advisory bodies are in place. An unattended stand (without even a notice) is a bit of a let down, and doesn’t convey a good message.

There was obviously much more stuff at the show, but many of the details unfortunately got lost as my virus started attacking me the minute I was on the train home. To find out more? You’ll just have to come next year!

In the meanwhile, here are some pictures:

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There were big cars…

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There were little cars…

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Cars that look like balloons

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Cars so mean they need to be fenced in

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Cars Boats so comfortable that Fluffly Huskies rest their tired heads on them

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Looks like a normal Firetruck…

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…but it’s a rolling Social Media advertisement!