Tag: paramedic

Collaboration & Specialisation

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I recently attended the Blue Light Collaboration Conference in London representing the College of Paramedics. I was initially a little sceptical, as I don’t have much to do directly with collaboration between services apart from direct contact with them as an on road paramedic, but then I thought this may be a good opportunity to meet new people, see different perspectives and get some other thoughts.

And it delivered. There were many delegates from various UK Fire & Rescue Services, plus a few paramedic, police and government representatives. Due to this, the main `topic was the collaboration between paramedic and fire services – co responding, emergency response, joint response…different names for basically the same thing: Fire & Rescue Services with their decreasing workload assisting Paramedic Services with their increasing workload.

There are a couple of different models how this works, but the most advanced and integrated (or overlapping?) model comes from Lincolnshire, in the East Midlands of England. There, East Midlands Ambulance Service (EMAS) and Lincolnshire Fire & Rescue Services (LFRS) have been working together in an official capacity since 1998, and their current setup is a natural progression of pure first responder type scheme: In a UK first, Fire & Rescue are actually manning three ambulances.

In my opinion, the pros outweigh the cons: The Fire & Rescue Service have capacity to spare. Their workload has gone down significantly over the past decades, but the public still deserve a good level of fire protection. In between fire and rescue calls, there is only so much training one can do – why not utilise their time for medical transport? Ideally, fire cover should not suffer from this model, but have a thought and compare: the risk of morbidity and mortality of medical origin (mainly cardiac) outweighs the morbidity and mortality of a fiery origin by quite a high factor. Both Paramedic and Fire & Rescue Services have one single task when broken down to the bare essentials: to serve & protect the public. Why not collaborate in order to maximise our efforts and outcomes?

This direction also got me thinking one step further: What if Ambulance Services (you may have noticed I have been avoiding that term) focus on their core strength of providing healthcare to the public, and “outsource” the transport side of operations to other services or suppliers?

A true Paramedic Service would take requests for help from the public, and point them in the right direction. If they can be helped at the point of their initial query and be referred on to more appropriate services (e.g. home care, GP, pharmacy), that works in favour of the public (accessing the appropriate care as timely as possible), and in favour of the service (only sending paramedic resources to the patient when appropriate). If a Paramedic is required at the scene of an incident, they can decide if transport is necessary. All this is already happening in some services around the world, but lets take it one step further: The Paramedic on scene then needs transport capacity, as they respond in mobile rapid response units (fancy speak for cars or minivans). Enter Fire & Rescue Service: they provide the transport capabilities, with basic life support dual trained fire fighters. Should the patient be stable and only need transport, they they can be transported. Should they need ongoing paramedic intervention and/or monitoring, the paramedic can hop in the back of the fire ambulance, and paramedic care can be given en route until handover at hospital.

Currently, there are only three Fire & Rescue (F&R) Ambulances in Lincolnshire supporting the Ambulance Service in a transport capacity. But if F&R took charge of the entire transport side of things, Ambulance Services could turn in to dedicated Paramedic Services, and focus on delivering high quality paramedic care to the community, without the overhead and distraction of not only fleet maintenance but number of other areas. F&R Service would be able to use their resources more effectively, and not have to close fire stations, thus keeping up fire cover for the public.

The above lines are only a thought experiment taking the Lincolnshire model one step further, but it is an option to be considered. The people behind the pilot programme in Lincolnshire are due to publish some numbers based on their facts and figures over the past month (the preliminary data, I’ve been told, is promising). It will have to be properly evaluated and adapted to local needs, but  I believe this could be quite an exciting game changer. I will be watching these developments carefully and with a lot of interest.

Minimum skill levels on emergency ambulances

If you phone for emergency medical assistance, you would think and hope that there is some sort of minimum set who will actually respond to your call for help.

Call in Germany, and you will be guaranteed that the arriving ambulance is staffed with at least one Rettungsassistent (see paragraph 25 of the Durchführungsverordnung HRDG vom 3. Januar 2011, this is for the state of Hesse).

Call in England, and…well…you might get a Paramedic, or a Technician, or both, or an Emergency Care Support Worker, all three, a mix…it’s up to the individual service. All I could find was the Health and Social Act (Regulation 22), which merely states:

In order to safeguard the health, safety and welfare of service users, the registered person must take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity.

 

To me, that reads a little like “if you can get by, then you’ll be alright”.

It’s high time for some research to be done in to this (I’ve just started), to ensure that skill levels when staffing frontline ambulances are evidence based, that they are cost effective, that they can deliver the care when and where they are needed. In other words: When a patients needs help, they get the help they need.

A Decade – part three

Seventeen years was enough. I wanted to experience living in Australia as an adult, not just visiting it. So I packed my bags and moved.

A massive leaving party, and a short holiday later, I arrived in Sydney with two suitcases, two guitars, and a bike. May as well do it properly and start from scratch!

Ambulance Service? A thing of the past. As much as I enjoyed it, being a paramedic is not a job for life, working in IT gives you more career opportunities, pays better, and is far more mobile. To be filed under “past experiences and enjoyments”.

I enjoyed the change in scenery. But I also remember spotting my first ambulance even on the taxi ride from the airport to the friends house I was staying at for the first few weeks. I just like the design, I thought. Just to look.

Work was good. I was getting paid, was getting experience, I had some pretty good colleagues (including the woman that used to sit opposite me who now sleeps next to me). It was on a holiday over to the west side of the country to visit my mum that I was able to organise an observer shift with the ambulance service – I was curious how the Australian system worked, and wanted to compare it to the German system I had experienced over the past three years.

I got dropped off at the ambulance station. The day crew weren’t back yet, and the night crew (I was going to follow them through half the night) hadn’t come in yet, so I waited for a few minutes until my aunt’s colleague’s flatmate (yes, you red correctly) turned up, who I had organised a shift with. In his final year as a paramedic student, he was happy to take me out and who me the Aussie way.

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A brief tour or the van, checking the drugs and equipment, I didn’t have much time to sit down until the first job came in. I can’t remember what it was, but what I do remember is that feeling of sitting in an ambulance again. This one was considerably smaller, made woo woo noise instead of neenaw, and had the addition of red and white flashing lights over the european blue I was used to – but each ambulance I have sat in makes a similar noise; the rattle of equipment in the draws, the crackling of the radio, the strain of the engine when the accelerator is mashed to the floor. In addition, all the other feedback was right too, the vehicle been thrown around corners at high speeds, the clinical white interior, the lights bouncing of the surroundings at night time. It all fit perfectly, a feeling and experience that I hadn’t had in a while. Quite nice, and good to know that it doesn’t differ much from Germany. Still hope that the university get back to me to tell me if I’ve been accepted for my bachelor in computer science, I’d like to progress my career in IT.

We drop our patient off at the hospital, and that is where I notice the biggest difference: it is all one service in the city. You see, in Frankfurt, the Fire Brigade had central oversight and control over EMS, and manned some ambulances. Additionally, the Samaritans, the Red Cross, St Johns and the Maltese Cross all ran ambulances in the city, under governance of the Fire Brigade. Five organisations, five employers – and people from different organisations didn’t mingle, it seems. But here, here in Australia, everybody knew their colleagues, they all wore the same uniform! I was introduced as the guy from Germany who wanted an insight in to the Aussie system, I was made very welcome by everyone else. The shift progressed, and I was able to have a good chat with the crew. Once again, we cleared from hospital, and were told that there were reports of a car crash coming in – one ambulance had already been dispatched, but in case backup was needed, we should head in that general direction. And sure enough, a few minutes later we were called to proceed under priority conditions to the scene.

And what a scene it was: The police had blocked the road, the fire brigade were cutting the roof off one car, whilst the ambulance crew on scene had split and were dealing with what was to become our patient, and another one who was in (what I now know as) traumatic cardiac arrest. Both young, having fun, but one of them had a bit too much of a lead foot for their guardian angel to keep up – even the paramedics weren’t going to change that. I was told to stay close to the ambulance, and was happy to do so – I was happy to take a back step on this chaotic scene, try and make sense of it all, get a general overview. A manager turned up, one that I had met earlier at hospital, who reminded me that if I didn’t want to see what was happening, I could sit in the back of the ambulance and shut the door; he made sure I was OK with the whole situation. I was.

After transporting the patient to hospital (I assisted, upon their request, by keeping the attendant up to date on the patients vital signs…OK I may have gone slightly overboard with the constantly changing heart rate until I was gently told to shut up 🙂 Iwas dropped off at a taxi rank. The crew took off for the rest of their shift, and I returned back to my mums place, deep in contemplation of my newly gained experiences of the life of a Paramedic in Australia…

 

Hello, my name is

Hello, my name is anonymous

 

It is early in the morning, the break of dawn. A small army of heavily armed specialist police officers congregate behind a wall, around the corner of a house where a wanted suspect with a violent history is suspected. Police intelligence states he may very likely be armed. Last tactical plans are run through again, all members take their positions: Snipers are in place on the rooftop, a group of officers provide firearm cover behind trees in the front yard. The crashing of the battering ram against the front door pierces the silence, breaking it down on second impact.

The armed officers storm the building, guns drawn, making their presence very clear:

ARMED POLICE CARS! WE ARE ARMED POLICE CARS! SHOW YOURSELF! HANDS ABOVE YOUR HEAD!

Unfortunately, the suspect sustained a fatal gun shot wound from the police after laughing so hard he could not comply with the above shouted instructions.

– ~ –

Similar scenario, but instead of a violent criminal, inside the house is someone with a medical emergency who requested the attendance of health care professionals. Instead of a battering ram, a gloved finger gently pushes the doorbell…*ding dong*. Nothing can be heard from inside.

Ambulance! Hello!? Can you hear us? Ambulance! Hello!

No laughter this time.

So why is it acceptable that us paramedics are identified by our primary mode of transport? You may know I follow the International Paramedic naming convention, I even wrote more about it last year.

Now, having been in the UK and getting to know the system more, some difficulties arise. Not only is it very common for people within our profession to refer to themselves as “ambulance person” doing “ambulance work” – local legalities leave them little else to say it seems. The title “Paramedic” is protected in the UK – if you are not HCPC registered, yet still call yourself a paramedic, you are breaking the law. Plain and simple, great for the public, great for the profession (our Australian colleagues look over here with envious eyes), but it leaves us lingering with the question: “What do we call those who work alongside paramedics, but aren’t paramedics?”

There is only one level of Paramedic registration. A Paramedic here has a multitude of advanced skills and to become one nowadays, it is mandatory to have a degree in Paramedical Science. UK Ambulance services aren’t going to solely employ paramedics, they are teamed up with either (Emergency Medical) Technicians (a dying breed of BLS trained colleagues) or colleagues with very basic medical training (approx. one month),  and a driving licence that are called either Emergency Care Support Workers (ECSWs, Emergency Care Assistants (ECAs), Accident and Emergency Support or something in between. Their (unregulated) job is not officially recognised as that of a clinicians.

From personal experience, the vast majority of them a great people and a real asset to work with, generally eager to learn more with the prospect of becoming a paramedic in the future – but their meagre (official) training keeps them locked in a low rank that we cannot call a paramedic.

So – what to do?

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…

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.

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.

M.A.N.E.R.S.

[youtube http://www.youtube.com/watch?v=BScY-ojApA8]

The above video was recently posted on the International Paramedic google group.

Recommended viewing for all Paramedic and related staff – suggestions on how to deal with psychological trauma.

  • Minimise Exposure
  • Acknowledge the impact of the event
  • Normalise the experience
  • Educate as required
  • Restore or refer
  • Self care

M.A.N.E.R.S. was developed by the Victorian Ambulance Counselling Unit (didn’t realise that vehicles needed counselling…).

Some more information can be found here (search for M.A.N.E.R.S.)

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.