Month: March 2013

LondOne, Two, Three!

Omne trium perfectum – everything that comes in threes in perfect

After gaining some interesting insights how paramedics operate in London by riding out with Lysa Walder in 2009 and InsomniacMedic in 2011, the year has come where I put myself in the hot seat and actually work in London.

After two shifts in the capital of the United Kingdom, the largest city in Europe and one of the most vibrant and exciting cities in the world, what does Yours Truly think?

In brief: Yours Truly is happy. It’s busy, there’s traffic everywhere, there are people everywhere, and its not hot.

Some of my initial impressions in a bit more depth include:

– it’s much busier. Generally you will get a job the minute you begin your shift, and then when you clear or “green up” at hospital or whoever you left your last patient. This is good, this keeps me awake.

– in these two twelve hour shifts I’ve possibly encountered as much heavy traffic as I have in two years in Perth. Again, this is good (yes, I know you think I’m mad)

– Roll In, Roll Out stretchers are nowhere to be seen. The majority of ambulances have tail lifts, some have ramps. Much more back and shoulder friendly. This is good, obviously.

– whilst we’re talking equipment, the vehicles are bigger here too. Funny – when you think of it, in Western Australia (WA) we had wider roads and less traffic, but smaller vehicles…go figure. In the UK, at led thou can stand up straight in the back of the vehicle even if you are taller than 160cm. I like this. A lot. The only thing I miss are the red lights lunching off the walls at night – UK law states no forward facing red lights allowed on any vehicle.

– being a bigger city, there are obviously more ambulance on the road, and many more paramedics on shift. They’re everywhere, impossible to know all of them, which makes it all a little less personal…but on the upside you get to see and meet new people every time. And not only London Ambulance Service paramedics, there are various private frontline service staff (like myself), people from neighbouring services and patient transfer staff milling around too – an interesting mix. In Australia every state or territory has one single statutory ambulance service. UK ambulance services seem to like to contract private services to cover peak periods. A new concept to me.

– FRU, RRU, PRU: Fast, Rapid, or Paramedic Response Unit. Different names, same thing: single responders in a car that are sent out to get to patients quicker. Again, this doesn’t really exist in WA. A new experience for me arriving at a patient that is already receiving paramedical care.

– not only are there different response vehicle types, but also more levels of responders. Every frontline emergency ambulance in metropolitan Perth is either a double paramedic or a paramedic/student paramedic crew. Here, very rarely do two paramedics (as in UK HCPC registered paramedics) work together. Frontline crews are usually made up of either a Paramedic or an (Emergency Medical) Technician as the clinical leader, teamed up with a Technician or a driver with advanced first aid skills (ECA, Emergency Care Assistant). In WA, I was one of many paramedics. Here, I am one of many paramedics too, but also with many technicians and ECAs, who have a lower clinical rank. I was at a job where we were backed up by a double technician crew – I was the only paramedic on scene. New experience working in the city and being the only ALS trained person on scene.

– i=Information. We all know that the information sent to us by Comms/Control/Dispatch is hazy at the best of times…and that is not their fault (well, not always, but we all make mistakes occasionally!). Easy fix? Don’t give out much information. Typical call out info for me, apart from the address, was: “49M, sick” or “23F, OD”. No names, no background info, if there was any hint of danger on scene they would radio that information through. I was used to much more information being sent through (that was generally inaccurate)…after an initial light shock at the lack of information I started thinking this may not be such a bad idea- at least it gets you thinking in many more directions; especially as a student I noticed I (and many other colleagues) would easily be lend and fooled by on screen information that had nothing to do the the main condition the patient was presenting with.

– uniforms: yep, they’re dark green too, but that’s where the similarities stop. I’m wearing epaulettes (a word nobody seems to be able to spell correctly) again, but unfortunately UK paramedic uniforms don’t boast reflective strips anywhere except on the jackets.

…and what about the patients? A bit early to tell, but for a general summary: people are people. Same problems, slightly different way of tackling them. What I have noticed in some is the typical British stoic stiff upper lip and politeness, manifesting in a stubborn “I’m perfectly all right, thank you” (no, you’re not), and “it feels like I need to…well…this sounds rather awkward…like I need to fart. Sorry for being so rude!”

To which I reply: “Stop being so British!”

And then there’s the sightseeing. I going to parts of London I haven’t been before. I was telling my crewmate the other day what would be the peak of my paramedic career: driving around Trafalgar Square on Blues’n’Twos, followed afterwards by parking the ambulance up on Westminster bridge and getting a photoshoot of the “man and his van” with Big Ben in the background.

“You’re such a tourist!” she replied with a smile 🙂

Pommy Pack

My first paramedic tutor shared a great tip with me once I added cannulation to my skillset: “keep everything organised”

He always kept a supply of so called “pommy packs” with him (yes, he is a “pom”); everything needed for cannulation in one handy wrap.

As a student learning cannulation, it took my mind off having to gather everything needed for the skill, thus enabling me to focus completely on the task at hand, and knowing I had not forgotten any crucial bit of gear.

Here’s what I do:

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Grab a “Bluey”, a large sheet of plastic on one side and absorbent cloth on the other. I lay this under the cannulation site, saves the apologies and embarrassment of blood on patients furniture or carpets in case of drippage.

 

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Fold a tissue – some cannulations can get messy!

 

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Add your Tegaderm, or whatever else you use to secure the cannula

 

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Add your favourite cannula sizes – I always had an 18 and 20 gauge needle with me, if I needed anything other sizes, they would be close by with the equipment.

 

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Add alcohol swabs. Two, one for backup or particularly dirty  patients (mechanics etc)

 

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Saline and Syringe

 

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Fold ‘er up on the sides…

 

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…roll…

 

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…and roll…

 

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…and roll again. Secure with a bit of sticky tape, or an elastic band. I wrapped a tourniquet around my pack, to have one handy.

Now, go ahead and make your own pommy pack, you’ll love them!

Your view

Know the facts.

What are the facts?

 

Know the truth.

What is the truth?

 

That is something you will have to find out for yourself. You must judge what you find acceptable, reasonable and plausible. Your view of the world through your eyes is unique. Your reality is different to that of your neighbour.

Are you colourblind? Then you will perceive the world differently than those who aren’t.

Are you left handed? You will have made different experiences than right handed people.

 

There are no hard and fast rules.

This is what makes things so complicated.

This is what keeps things interesting.