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Contemplating life.

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?

Untitled

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.

Perks of the profession

Image via Wikimedia Commons

When I was still working in Information Technology, choosing an employer was always linked to certain benefits that could be an important factor. Working for a large telecommunications company saved me a bunch off my phone and internet bills. Other companies after that offered different extras. All the little things add up in the end.

When I changed career, one of the many thoughts I had was: “I’m not likely to pick up any perks here”. True, there is not much that Paramedic Services generally offer. In Australia I got free Ambulance cover, but that’s free (as it should be) here in the UK.

But take a step back. A few pounds off your phone bill is helpful. A couple of percent discount whilst shopping is great if shops offer you a discount for being a Paramedic.

What about your training, your knowledge, your experience, your insight?

That is an invaluable perk of your profession.

A few years ago a relative had to go to hospital, and although I was unfortunately working most days during their hospitalisation, I was able to pop by the ward a few times in between calls to say hi, talk to the nurses on the progress, and explain and reassure on a personal level what was happening. Not to forget the follow up research, little bits of advice and reassurance I could continue to give after discharge.

Similarly with my own admission to hospital last week – although I took my sweet time getting myself in to hospital in the first place – once in and with half a brain to function, I was actively involved in my care. Not that I was going to change anything – there was no need for that – but I could ask a few pertitent questions (Glandular fever is virus based, why the Antibiotics? We suspect you have an infection on top of that, so we’re attacking it from all sides). I knew what was happening, why it was happening, what drugs were being pumped in to me, checking that hygiene ‘rituals’ were being followed, and that generally everything was up to standard.

Whilst monetary compensation isn’t generally fantastic as a Paramedic, your insight, knowledge and experience within healthcare is invaluable. Don’t underestimate that.

Hospital Care: In or out of Hospital?

This little gem came to my attention today:

Saving lives by keeping patients out of hospital (via Croakey)

 

Here is the actual research article: “A meta-analysis of “hospital in the home”

My fuzzy brain is not up to its full standards, so I’ll leave you with the article and the comments from Croakey pretty much uncommented, but with a final thought:

This is our time. This is where the Paramedic Profession can shine, use its full potential, and have a profound positive impact on healthcare. With the science to back our practice up. And the unbeatable argument of delivering it at a good price too.

Emergency Services Show 2012

I will be at the Emergency Services Show 2012, held this week Wednesday and Thursday (21st and 22nd of November). Looking forward to meeting new people, catching up on the latest technological developments and getting some CPD from the College of Paramedics.

There will be a couple of us meeting up on Wednesday at 1215hrs outside the College of Paramedics stand (Hall 3, stand E71, floorplan here). I’ll be live-tweeting together with a bunch of fellow tweeters – be sure to follow the #ESS2012 hashtag.

Hope to see you there!

The Holy Grail of communication

[youtube http://www.youtube.com/watch?v=-8bqQ-C1PSE]

Make sure you know their name. Your communication partner will be thankful.

Names – the holy grail of communication.

Hero Revisited

Kelvin Crocker (@yellowspanner) emailed me in response to my recent post “I am not a Hero“. With permission, I quote:

Just to begin by saying that I don’t consider myself a hero in any way. My father was a firefighter and whenever the hero tag was bandied about he always said he was just an ordinary guy doing his job. I also believe that. But what about public perception? We drop in and out of people’s lives in extremis. We just get on with things when others would run away. Does this make us heroes? Maybe we are just the tip of the spear and all that back us up, the call takers, the trainers the vehicle mechanics are just as important and heroic in their own ways. But we get seen by the public and to be called a hero is something we should take and pay it back to those that support us on the front line. My kids are proud of what I do and also just as proud of their Mum – a nurse. Sometimes I think the word hero is misused – should we take the good meaning and ditch the bad?

Kelvin has a point, and a very good one too. I have a part of me that wholeheartedly agrees with him. We might not see ourselves as heroes, but if others would like to apply that label to us, we could and should use this positive description for the benefit of our profession.

I am not a Hero. I don’t see myself as a Hero.

But if you (genuinely) call me a hero – I will humbly accept the honour with gratitude, and share it with the profession.

Ormskirk

Yes, Ormskirk. A little town in the North West of England, 14 miles north of Liverpool. Bus driver, pub owner, town locals…all asking me the same question: “What are you doing here?!” It seems visitors, be it from London or from Mars, are a rarity. Ormskirk is not a place that prides itself on tourism.

Doesn’t matter to me, I didn’t get to see much of the place anyway. I was here for the Continuing Professional Paramedic Development – a one day conference put on by the UK College of Paramedics.

The day started off with Dr John Freese, Chief Medical Director of New York City Emergency Medical Services. A rather good speaker with an interesting background (John started as a basic EMT in the rural US, worked his way up to Paramedic, then turned to medicine). His talk was based around trauma care in the US, its history and direction of the future. Some interesting points I picked up:

  • Skill decay is a big problem amongst NYC paramedics. Intubation success rate is approximately 30%, many paramedics don’t even get a chance of intubating, and their average training is far less than that of an average UK paramedic.
  • For severe trauma patients, definitive care is needed. Where this care is provided best (i.e. what is the most suitable hospital), NYC EMS has developed a simple reductive flow chart based on patient presentations, events and mechanism in order to determine if a patient should be taken to a trauma centre, and if so, what level. An important note was emphasised: the clinicians decision. The chart could not indicate any need for higher care, but the paramedic must still be allowed to take a patient to the highest care facility if judged so by their clinical experience.
  • Then the big one: “Spineboards: they need to go”. NYC EMS has realised that far too many patients are immobilised for no good reason. Research is proving that immobilisation is possibly doing more harm than good. Currently, new guidelines are being written in order to drastically lower numbers of spineboard usage in NYC. Personally, I applaud this. A big step in the right direction.
This talk was particularly interesting for me, as I had just visited New York last year (if you’ve been reading this blog recently, I am just putting up the stories now). Very nice having seen NYC EMS, then hearing all about it from the Chief MD.
Up next was Professor Kevin Mackway-Jones, Medical Director of the North West Ambulance Trust (NWAS). The presentation was similar to the previous, but this time from the NWAS perspective – a much more diverse landscape with urban, regional and rural settings (something you wouldn’t find in NYC!).
  • To provide a similar level of care that urban area enjoy everywhere in the NWAS catchment area, another 14 full time helicopters and anaesthetist would need to be employed. Far too expensive and ridiculous, he explored the alternatives: Full time HEMS, vs on call residential doctors, vs volunteer doctors (e.g. BASICS), vs full time specialised (critical care) paramedics. The last option won – cost effective, good exposure means good quality, experienced, available and a good skill set.
  • Kevin agreed with John about spineboards, and repeated the overuse of the device, stating that many UK services are re-evaluating their use. Additionally, he stated he is not convinced by pelvic splints; there is not enough evidence to support them.
Next speaker was Professor Andy Newton, Chair of the College of Paramedics and Clinical Director of South East Coast Ambulance Service. After some information update from the College itself, Andy got us in the right mood with a clip from the Simpsons: Homer as an Ambulance Driver (could unfortunately only find it online in Italian). Some points Andy talked about:
  • The history of Paramedicine, especially with regards to the “founder” of out of hospital care, Dominique Jean Larrey.
  • The specialisation of the workforce. The police have a very specialised workforce: General duties, traffic, homicide, fraud…certain cops target certain crime. Paramedicine should (and is) heading int he same direction: Paramedic Practitioners for minor issues that can bypass the A&E department, Critical Care Paramedics for very serious cases.
  • Apparently providing Ambulance Services in the United Kingdom costs 2 billion Pounds annually (surprising actually, since London’s Metropolitan Police alone have an annual budget of 3.5 billion Pounds. Compared to the 282 million Pound London Ambulance annual budget).
  • Then a great point: “Paramedics as a disruptive technology“. Adapted from the business world, the point was made how Paramedicine is influencing healthcare, changing the way care is delivered (e.g. via Paramedic Practitioners), together with potential ways Paramedicine may influence the provision of healthcare in the future.
  • Another video, this time from a cardiac arrest in London from the early 1980’s. Horrible grey uniforms, ghastly hairstyle, but the intubation was spot on (unfortunately nobody cared about chest compressions…). Nothing how an arrest is run in 2012, thirty years later.
After lunch, there were two more presentations; Sudden Arrhythmic Death, and Obstetric emergencies.

In other words: Quite a good event. Interesting speakers, decent venue, and a good attendance. Can’t ask for much more! For those who would like an online summary, I did tweet most of the event under the #ParaUKCPD hashtag on twitter (should be visible on my timeline, dated 19th October).

Couldn’t make it? I will be visiting the Emergency Services Show in Coventry on the 21st and 22nd of November, tweeting and blogging again. Hope to see you there!

Together.

Silly people all around
bringing frustration to my day,
I wish I could just huff and puff
and blow them all away.

Far away and out of sight
finally I would be free,
of people not sharing my point of view
now left only with people just like me.

But oh, alas! No-one there
to do the things I can’t do,
Who will research cancer,
Who will make my shoes?

So in the end, a lesson learnt
no use to whinge and groan,
We’re in this all together
we can’t get there alone.

I can get annoyed with people. Self centred, cheap, inconsiderate, ill-mannered. You know the type. You know the type very well in fact. Because I just described you.

No, I’m not having a go at you personally, dear reader, just a certain side of you on a certain day. We all have those days. Rushing to get to a train, and accidentally elbowing somebody in the process. Asking where the washing up liquid is in the supermarket when you’re standing right in front of it. We’re all guilty of something, and with six billion of us on this planet, these varying little annoyances add up.

I can get annoyed with people. But – Paramedics treat everybody. Including people I get annoyed with. That is not a choice I have, nor a choice I should have.

Because everyone has their part in society. I don’t necessarily need to be best friends with them, but I would be stumped if there was nobody in the accounts department that manufactures my dishwashing liquid, or noone that produced the knives that my butcher uses to cut the meat that I find on my plate. Who would drive the train that gets me to work, and how would the rails be laid for that train to be able to run in the first place?

We all have our own role in society. We all have a part to play. Inherently, we all won’t be  best of friends – but we can live together, and try and make the best of the situation, remembering that we all have a duty in and to society.

Tolerate and Educate. Don’t Eradicate.

I am not a Hero.

“Unglücklich das Land das Helden nötig hat”

– Bertolt Brecht, “Das Leben des Galilei”

“Pity the country that is in need of heroes” is what Galilei states in Brecht’s play, after revoking his statement that the world is not the centre of the universe.

InsomniacMedic and I had a discussion on the latest topic on his page: “Unsung Heroes“. He writes that the term “Hero” is used far too often, and applied broadly (and all to frequently blindly) to many a person who hasn’t done anything heroic.

I agree, and would go even further. But before I give you my opinion, let’s all start on the same page, and get the definition straight:

hero Pronunciation: /ˈhɪərəʊ/

noun (plural heroes)

  • a person, typically a man, who is admired for their courage, outstanding achievements, or noble qualities: a war hero

from: Oxford Dictionaries Online: “hero”

Like any definition, they are subject to personal interpretation.
Latest teenage pop sensation? Could be admired for their outstanding achievements…
Latest world-class footballer? Could be admired for their outstanding achievements..
Latest life-saving paramedic? Could be admired for their…

Hang on a second, old chap.  What an outstanding achievement is to you, doesn’t necessarily make it one to me. Me? I’m a paramedic. It’s what I do. It’s what I’m good at. I may have saved a life or three. But I couldn’t have done it without the hospital staff. Or the guys who built the ambulance. Or those who made the defibrillator that shocked the patient from Ventricular Fibrillation to a normal sinus rhythm. They’re all people doing what they do best, helping put the pieces of the puzzle together.

That hero, that batman or superman that everybody expects to singlehandedly fix everything in a time of crisis? Fiction. Made up. Will never be. Should never be.
Because if you need a hero to singlehandedly save the day, it means that you, your friends, your family, your society have failed working together as a whole.

 

“Unglücklich das Land das Helden nötig hat”

 

“Pity the country that needs heroes”

 

I am not a hero.

Hobart – use the Hashtag! #PAConf2012

Next month, the 2012 Paramedics Australasia Conference will be held in Hobart, Tasmania. I was fortunate enough to be able to attend the 2010 and 2011 conferences (and even present at the last one), so it is a little sad that I’m missing out this time.

Two things I ask of you:

  1. Please attend the conference
  2. Please keep me up to date by live-tweeting the conference with the #PAConf2012 hashtag.

Pure selfish reasons, I know, but I do want to keep an eye on the mob Down Under, they are a good bunch!