AmboFOAM

I never thought that I would come out of blogging retirement. Didn’t have anything else to say. But a rant has been brewing for a long time now, building to dangerous levels. If I don’t get it out now, I’m liable to give myself a rupture, and then I’d have to wear a truss, and I don’t need that. Nobody needs that.

I’ve been largely desk-bound for the last 6 months or so, which I have to say I don’t love – my happy place is out on the road looking after a sick person or two and doing some bedside (roadside) teaching, but it’s an opportunity to have a positive impact beyond day-to-day patient care, and I’m pretty excited about that.

What it has done though is give me a lot of time listening to the radio, being jealous of crews going to cases I’d like to be at. However, having listened to a lot of radio chatter I have some advice for my MICA colleagues:

Be. Quiet.

Specifically, to those who feel the need to back-seat drive a case when you are not there yet: don’t. Stop telling the crew on scene how to do their own job. They don’t need to hear you reminding them to transmit the ECG, or notify the hospital, or give dextrose, or any of the other inane ‘advice’ you feel the need to give.

It is unnecessary, it is condescending, and it is bloody rude. Show some basic respect to your colleagues, and run with the assumption that they know how to do their job. They have requested you to attend to provide care that is beyond their scope of practice or because guidelines mandate that the case is escalated. Give them the common courtesy of letting them get on and do the stuff they can do, turn up and be nice to them, and do the things that you can do.

IF there have been elements of care that have been missed, or could have been done better, then by all means, have a collegiate chat afterwards about how they can improve their practice. But that chat doesn’t happen over the radio when you haven’t even clapped eyes on the patient. The paramedics on scene have better things to do than listen to you talk down to them, and the dispatchers have better things to do than facilitate you talking down to crews.

The only thing you need to say on the radio is “Received thanks” when you get the job, and to arrange a rendezvous point. Otherwise,🤐

Hello from the world of ambulances and other emergency services!

We hope you have an excellent Christmas and holiday period. It’s a fun time and people are usually in a good mood at the end of a working year. It’s a time to spend with family and friends, to eat and drink, and generally try to reconnect with humanity.

But please look after yourselves. Historically the Christmas period has been a bad time for certain types of problems. People often crash their cars at this time of year because they’re travelling long distances to see family. They may also be overtired or drunk, which is rarely a good idea.

New scooters and other toys are also common sources of injuries – supervise your kids and make sure they have appropriate protective gear. Pools are another big risk – it’s hot weather in Australia, but you can’t supervise your kids from inside the house, and especially if you’re halfway through your second bottle of wine.

Big kids hurt themselves too – new power tools are a classic. Read the manual first and wear goggles. No-one wants to go to hospital on Christmas day because they’ve lost fingers while playing with their new circular saw.

Sadly, this is also a peak time of year for suicide and family violence. If you know someone who doesn’t have family at Christmas, invite them to your shindig. The only thing worse than being alone is knowing that everyone else is having a great time.

Lastly, don’t forget about the people who are working over Christmas to keep you safe – paramedics, police, fire/rescue, military, prisons and border security. We’re obliged to work, regardless of what our family situation is. We’d rather be at home, but this is our job and we understand the way it works. Still, we’d appreciate it if you didn’t create more work for us.

Have a great Christmas and a happy and prosperous New Year.

Robbie & James

Ultimately, a lot of what we’re doing in EMS is ferrying people towards their deaths. 

In the literally-true-but-irrelevant sense, we’re all dying. But that’s not what I mean. Pre-hospital and Emergency workers spend a lot of time around people in their final hours and days, even though we don’t always think about it. 

It’s easy to get fixated on the “glory job”, the case where our care may be able to prevent the death of a young and healthy person. But those cases are relatively uncommon.

Most of our time is spent with the very old and terminally ill. It takes a lot less to kill these people and a lot more to “save them”. And they’re not glamorous.

It’s not the car crash, it’s the third pneumonia in a year. It’s not the knife wound, it’s the complications from surgery for a broken hip. Some people have the smell of death on them.

Most of the time we can’t prevent death, we can only ease the suffering.

We can treat the patient with dignity. 

We can leave a coin for the ferryman.

Link time: First10EM.com has published an interesting article/brain dump on performing under pressure in the setting of emergency medicine.

There’s a lot in there, but the key takeaways are that “stress” is inevitable, but varies a lot from person to person. The trick is to optimise your response to stress so that it helps you to do your best work.

Have a read.

It’s time for another post on everyone’s favourite drug: ketamine!  Hooray!

Ok, so this is not entirely about ketamine, but ketamine does come into it.  AV paramedics have recently received training to administer IM ketamine to agitated patients as part of a greater focus on paramedic safety when managing these situations(MICA paramedics have had ketamine for a while, it is now used by all paramedics)

Speaking with crews since the roll-out, there seems to be some confusion around some  aspects of managing these patients, so I thought I would attempt to exacerbate alleviate that.  This post is pretty specific to Victoria I’m afraid, so everyone else might want to find a more useful blog to peruse (i.e. any other blog).

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