Tag: ambulance

SwissScapes

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OxyBear is saturated.

 

_MG_1209StethoLion hears you breathing.

 

_MG_0940Emergency!

 

_MG_1183 …whilst it’s cousin naps, solemnly waiting for an emergency of it’s own…

 

IMG_8204…wishing it had a bed of it’s own, an actual ambulance bed…

 

Thanks to Martin Greca for the photos. They are Creative Commons licence, but please get in touch with me via the Contact! page if you want to use them.

Design

Design, a sometimes forgotten and neglected topic not only in the Paramedic world. Examples include the often poor visibility of exterior ambulance design, unsafe practices on interior ambulance designs, hideously designed uniforms, and not properly thought through industrial design of the equipment we use (heavy, cumbersome, unreliable, expensive. Or all four).

One thing that has always bugged me 
is the utilitarian approach to designing the patient area of the ambulance. Essentially the Paramedic’s office, a bit more thought would go a great deal. I was reminded of this shortcoming today when I visited the London Design Museum. There are some great designs and designers on this earth, but apparently we need to stick to old-thinking style layouts, with the accompanying drab and depressing colours. How about improving our workspace – I’m sure it would have a positive impact on   happiness at work, and even a good effect on (conscious) patients and bystanders. Environmental perceptions shouldn’t be underestimated.

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An interesting piece of ‘design’ was the Music Memory Box, designed to help dementia sufferers. The box is filled with objects and tunes that the individual has a strong emotional bond with; these ties are still present even with advanced dementia, and can provoke quite startling emotional outbursts. I can already picture a bunch of poor demented paramedics in a nursing home, with somebody having put the radio tones for a call in the Music Memory Box. The otherwise quite placid retiree would come out with a strong “Oh damn! Not another call, I wanted to eat my lunch!”.

 

I’ll leave you to ponder with a picture and a quote from a sculpture outside the Design Museum:

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Though human genius in its various inventions with various instruments may answer the same end, it will never find an invention more beautiful or more simple or direct than nature, because in her inventions nothing is lacking and nothing is superfluous.

Leonardo da Vinci.

 

 

Further reading & Links:

Ambulance Visibility: ambulancevisibility.com

Ambulanzmobile: Delfis Ambulance Design: http://www.ambulanzmobile.eu/brand/en/models/emergency-ambulances/delfis.html

Design Council: Making Ambualnces that don’t kill people: http://www.designcouncil.org.uk/publications/design-council-magazine-issue-3/making-over-the-ambulance/

London Design Museum: http://designmuseum.org

Transport Design of the Year 2012: Redesign of the Emergency Ambulance: http://www.designsoftheyear.com/tag/redesign-for-the-emergency-ambulance/

Music Memory Box: http://www.watershed.co.uk/ished/projects/music-memory-box/

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.

NYC: Maimonides Medics

June 2011

The day had come: Time to see what New York City Paramedics do. The grime of the city. The hustle and bustle. The intensity. The size. New York City. I was excited.

I had sorted a shift out from Australia via some contacts (thank you again if you’re reading this!). A few emails and a phone call later, I’m booked in. After borrowing The Worlds Smallest Ironing Board from the hostel, coupled with The Worlds Worst Iron, my crease free shirt (NOT!) and I were on their merry way to Brooklyn.

The Subway, or any underground train for that matter, is a semi-magical type of transport. Descending in the the depths of the earths core, you are whisked away in a steel can on wheels, propelled through a network of subterranean tunnels, only to submerge in a completely different biotope.

I felt like I had come out on the Wrong Side Of The Tracks:

[youtube http://www.youtube.com/watch?v=uAFDeC7TVyQ]

…and when you’re in f*ckin’ Brooklyn, you best watch your back!

Woah. Dirty streets, rubbish lying around, big mean-looking guys with tats walking around. A dark freeway underpass. A broken fence. I looked around, and felt like the proverbial sore thumb sticking out. No one really took notice of me, but There was no way in the world I was going to do anything to draw further attention towards my person. No way was I taking my iPhone out to take pictures. I made sure my valuable were as safe as possible, and out of sight. I morphed in to “man on a mission”, and headed straight to the ambulance station, trying not to leak any signs of curiosity of the neighbours or indeed the neighbourhood. Because I was just that – curious. But I was attached to my health and my life. (I’m sure this was a bit of an overreaction, but you can never be sure…and this was precisely the landscape that is always portrayed in various US gang films…).

I arrived in one piece at Maimonides EMS depot (pronounced May Mo Nuh Deez. Maimonides was a medieval Jewish Scholar). Phew. Knock Knock? Noone. I walk in, and am greeted by some paramedics, who direct me upstairs to the supervisors office. A few doors and some very narrow stairs later, Henry greets me with a big smile, welcomes me, and eagerly gets right in to it: “Let’s head downstairs, I’ll show you around and introduce you to the paramedics”.

We head back down, but the crew for the shift is not there yet (admittedly, I am very early).  “Here, I’ll show you your truck!”. And yes, it really was a truck:
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We chat for a short while about the service, but then his phone rings and Henry excuses himself. “Grab some food in the meantime! It’s EMS week, help yourself, go right ahead”. Well, free food, can’t decline a friendly offer, can we? The banquet had been ransacked by earlier crews (it was early afternoon already), but still plenty to be had.
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Eventually, some people in uniform wandered in, who turned out to be the medics I would be riding with soon. We go through the different kit they carry, compare each others respective guidelines and protocols, and are bleeped immediately for a standby position. You see, in New York, all Ambulances except FDNY (pronounced fid-nee, or fud-nee if you’re from New Zealand) get dispatched from street corners, not from stations (more on that in another post).

Halfway to our streetcorner, we are sent on our first job. Oh yeah, this ALS truck is now running hot! Big, boxy, bouncy, bad. Together with the fine and silky smooth roads (NOT!) of NYC, it would make for quite an unpleasant ride if I were not so excited. And another thing: Drivers of all emergency vehicles are quite playful when it comes to sirens: wooowoop. wup. wuup woop. wooohoooowailwailwail. woop. wail wail. HONK yelp yelp HiLo. HONK woop.

A haemophiliac in a high rise building has called, thinking he has broken a bone. We’re in “The Projects”, the New York term for low income (generally ugly high rise) housing. And I get the picture pretty quickly: Dark and dirty entryway, a lift smelling of stale urine with goodness-knows-what smeared over the graffiti. Creaking, the lift sneaks us up multiple floors, spits us out in a tight hallway, where mum (or should I write mom) awaits us: her brother has a bleeding disorder, heard and felt a snap in his thigh, which is now slightly swollen and tender. And he can’t weight bear.

Luckily we have the carry chair handy.

Our patient is comfortable as long as he isn’t standing, but the upper leg is tender to touch. All vitals within normal range, declines pain relief, so apart from monitoring and transport there is is not much more to do.

We arrive at hospital after an uneventful transfer where, once again, it becomes painfully (for the seasoned US medic, not me) obvious of the stretcher systems that are in place in most of the US & Canada: Person A must hold half the patient + stretcher weight, whilst Person B must fold or unfold the legs of the stretcher. Man, you gotta hold a lot of weight, that can’t be good for your back! I think that topic alone is worth an additional blog post (at the risk of even more wrath in the comments section)

Back in the van, restocked and roomy (yes, this thing is rather large), we are sent to our street corner again. Not a bad corner, as far as street corners go: Close to a major road, yet quiet, a supermarket for food nearby, and free public WiFi.

And we wait for another job.

And wait.

And wait.

And wait.

And fall asleep.

A nine hour shift with one job. It’s light. Nothing. Then it turns dark. Nothing. BLS crews whizzing past us on lights and sirens. NYPD screeching past. Firetrucks honking their airhorns as they hurl past. But this ALS crew isn’t needed anywhere.

Observers Curse.

Streamlined

Studying for my C1 licence here in London (you need a light truck licence to drive ambulances here, unlike in Australia), I realised that most North American Type III ambulances don’t have cab-mounted wind deflectors. Yet nearly all european box-type ambulances do.

Compare the wind resistance of the boxes of these two vehicles:

vs.

Far more streamlined, which would equate to better fuel economy, less running costs = $

Additionally, they deflectors can house warning lights, heating or air conditioning units, or more space for gear. InsomniacMedic pointed out that though all regular London Ambulances have wind deflectors, the Baby Emergency Transport Service (BETS Ambulance) does not, due to weigh limitations…it was either the deflector, or the incubator.

I personally believe that is the exception rather than the rule.

Now to you, paramedics, purchasers and coach builders, what do you say?

 

Edinburgh: ParamedicPictures

May 2011:

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With the notorious “Scottish Cuisine” in abundance, you won’t be out of a job anytime soon in Edinburgh.

 

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At first I thought it was a police car. But then I realised the difference!

 

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Guess who’s mug that is?

 

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Different (in my experience) way of checking a patients temperature

 

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All ready for a busy shift!

 

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Honda honed and ready to go.

 

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Edinburgh ambulance station

 

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The man himself, with that awesome green uniform (seriously, I’d work there just to be able to wear bright green all day long!).

Note that he is actually not a man, or a paramedic, but an ambulance, although he does look quite different to the thing in front of him on four wheels.

 

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Here be the front.

 

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Here be the back.

 

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Here be the insides!

 

We have something in common…

Getting a good medical history from patients can be difficult at times. “Do you have any additional medical history” often returns a negative answer…although the three tonnes of prescription drugs on the coffee table indicate otherwise. So I came up with additional questions:

Me: “Have you ever been in an ambulance before?”

Pt: “Yes, recently, my heart was playing up.”

Me: “I’ve been in an ambulance too.”

Pt (shocked expression): “Oh my, why was that?!”

Me: “I work in one…”