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Contemplating life.

This means nothing to me…oh Vienna!

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Schloss Schönbrunn. And snow, lots of it, in fact!

 

Actually, it meant quite a lot – so enough of the reference to 80’s pop music. I chose Vienna for my birthday destination because….well, I don’t really know. I had been before, couldn’t remember much – I believe I had not hit my teens yet, and as such it was a few earth rotations around the sun ago.

Vienna turns out to be a beautiful place, with spectacular old buildings, scrumptious food and a sophisticated yet laid-back cultured vibe. I can only recommend that you should visit it, and eat, drink and be merry there. I’m not one for much repetition, so I’ll leave you to check out my other halves delectable musings here.

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 Through conference attendances I had got to know some lovely Austrian Paramedic folk. As one does when visiting a country of foreign friends, one calls up (well, emails) in advance to organise a coffee together and the next thing you know you have a shift on an ALS response vehicle booked. Can’t help myself – and I count myself especially lucky as my other half is not only tolerant of such fun outings, but actively encourages me to do them (which she planned to turn in to some time to pursue her own interests, like watching some equine practice prancing. I might be losing some brownie points here, but I really can’t warm myself to horses. They have big teeth and don’t talk).

My alarm went off at 5am. Early? Yes. Girlfriend snuggled beside me on the mattress all warm and cozy? Tick. Could I have done with a bit more sleep? Indeed…but I was up and showered and ready to go in no time, excited by the prospect of experiencing another ambulance service!

After finding a little local bakery that mercifully opened early enough for me to buy all the danish (read: viennese) pastries within the city limits, I was fed and watered and awake to jump in to my Wiener Rettung (Viennese Rescue) experience. Now only to find out where I have to go…

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The Entrance Sign

As has often been the case in the past, someone saw me confused & pondering in front of the new building (the main building was closed and locked and dark), let me in and in a friendly manner pointed me in the right direction.

After a quick tour around the building (nice and modern, with beds, a comfortable communal, kitchen and outdoor area), and I am introduced to the Paramedic I will be following for half the shift. I say half a shift, as I only wanted to spend a coupe of hours to gain some insight, and not a whole day; it turned out to be a quarter of a shift, as the guys and girls in Vienna still do 24hr shifts, with the possibility of 15-20 jobs in that time frame. Phew!

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My ride for the day.

I was going out on the ALS response car that morning, with a Paramedic driving, and an emergency doctor treating. When I say Paramedic, I mean a person who is trained in emergency care, and – at the highest level – can intubate and cannulate. Nevertheless, they are still very transport focussed, and paramedics take a backseat in clinical care, leadership and development – most likely because the system is so heavily focussed on doctors as advanced providers. Even worse, Vienna is the only city in Austria that has an entirely career based ambulance service – the rest of the countries ambulance services release heavily on volunteer input. Often, I was told,  the ambulances are staffed with two volunteers with lower qualifications. Vienna is fighting this, and trying to bring forward the concept of a paramedic services within the country. They are doing a fine job it seems within Austria, but in an international comparison there are some areas where they are lacking.

But don’t write them off just yet, they have some interesting things to show to the world! They have just started a new level of Paramedic within the service. Qualified Paramedics are undergoing a three year course to further their knowledge and experience in such areas as critical care, primary care (community paramedicine), and field supervision (teaching and quality assurance), and they are building the course on input from a variety of international best practices – so hats off to them! I am looking forward to seeing them progress, and hopefully joining the international Paramedic playing field in due course.

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The ambulance garage. Obviously.

I went out on three jobs all together, including a 20+ minute run to backup a cardiac arrest. Not only was the job on the other side of the city, but it had also just started snowing heavily – and with heavily I mean approximately 15cm (6 inches) of snow in one morning. A standing and sliding ovation to the Paramedic I was with who safely navigated the traffic that morning.

And now, a few impressions, facts a figures from my shift:

Vienna runs approximately 35 ambulances throughout the day, additionally 6 ALS response units staffed by a Paramedic and a Doctor. The ambulances are staffed with three people – a wheeler, a healer and a dealer (OK, I made that rhyme up…one person drives, one attends and one is an additional pair of hands). This can get quite cramped inside the van conversion ambulances they use – working on a sick patient, there were two paramedics, a doctor and myself squeezed around the patient, and we could barely close the door. The service is considering in to larger vehicles for the future I have been told.

The Wiener Rettung only do emergency work, all patient transport is done by private and/or not for profit organisations such as the Red Cross or the Samaritans.

In the event of a cardiac arrest, the closest vehicle is sent – including the above mentioned patient transport vehicles or as well as the police as first responders. They are backed up by an ambulance and an ALS response car. The fire brigade are not involved at all – they were apparently invited, but declined.

There are no response time targets to be upheld, but a unit that has been alerted from station must be mobile within 2 minutes during the day, and three minutes at night.

Joining the service is an interesting path, one that I had not heard of before, some interesting ideas. After being accepted, either as a rookie to Paramedicine, or even as a qualified member, you start off doing station duties. You get to work, put on your uniform, and you clean and restock vehicles, inside and out. This is to get to know how the station operates, picking up the culture (e.g. cleanliness) and where everything is kept in the vehicles. If there is a staff shortage on that day, you will also man the ambulance if need be. After a period of station duties, you then progress to permanent on road duties.

After five years as a Paramedic, one can apply to work in the control room – this is often done by those who have injured themselves on the job and cannot work on the road, or those who have done their decades of work and prefer the slightly more controlled environment. Calltaking (via AMPDS) and dispatch is done at the same desk by the same person.

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Goodbye Vienna, hope to see you again soon!

I had a great time in Vienna, and being allowed to experience their ambulance system was the cherry on top of the trip. I would like to sincerely thank all involved for giving up their time in showing me around and meeting me, it was very appreciated.

Finally, I would urge everyone working in the field of paramedicine to consider visiting other services when they are on holiday. Not only do you get great insights and make some new friends, but you also get to see the area you are visiting from a local paramedics perspective – a view that is quite different than that of a tourist. Give it a go, I’d be very interested in your experiences.

For those wanting more information:

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!

Chunky Brown Sauce

“Unit Flobach, you are responding to Priority 1 trauma call, patient has vomited brown liquid”

Not quite sure where the ‘trauma’ bit came from, but I flagged it as a triage to be looked in to. Every system needs it’s tweaks.

I joke to my partner that the patient has probably drunk a large bottle of barbecue sauce. Quietly I am praying to the EMS gods that it isn’t faecal vomit.

We arrive to see a patient who had vomited Chunky Brown Sauce; with an intensely acidic smell attached. It is everywhere…bed, floor, walls. Quick cleanup, treatment, transport, the shift continues until it ends. Tired, happy but hungry, I arrive back home.

What’s for dinner?

Pasta.

With Chunky Brown Sauce.