Verbal first aid

Reading an excellent book at the mo called verbal first aid for kids.

I cant believe I have been practising as a paramedic for 16 years and I have only just cottoned onto how  what we say to a patient (or dont say) can have such an impact on their recovery process.

Ive just read a book called The worst is over by Judith Acosta who is  trained psychotherapist, hynortherapist and trauma counsellor. She emphasises how the language we use directly influences the recovery process for children. They look to adults for emotional cues. If they injury themselves and mother is a blubbering mess they naturally think the worst. If on the other hand mum acknowledges but downplays the event and remidns the child they are a quick healer then its no big deal. And guess what, the kids actually does heal up faster!

The same applies to adults. We go to routine chest pains which is no big deal for us as paramedics, but for the patient they probably think they are about to die! While we run off an ecg and chat to our collegue about it they are waiting with baited breath on whether  we think they are going to live or not....and we probably dont even reassure them they will!

I have started using proactive and positive language in my patient care and wow what a difference. Patients are definately less anxious. So check out the book and see for yourself how what you say can be as important as the medicines you administer.

You can read more about the book and author here

Getting home from hospital

This is a question I get asked a lot by people who have called an ambulance.

"How am I going to get home from hospital?"

Now I dont know about you but if I decide I need to go to hospital then part of my decision making will include how Im going to get home again. Our job is definately to take you to a medical facility (if we warrant that you really need to go to one) but our job is definately not to tell you how to get home again. Thats something you should really think about when you call an ambulance. We are a one way trip provider!!

The practice of medicine is the practice of compassion........however this is not taught in any medical school.                    Patch Adams. MD

Dr Patch Adams worked as a physician for free for 12 years. He had a night time job to support himself. He said he paid to practice medicine because it was such a priveledge to do so! His practice included spending 4 hours with every patient during his first consult so he could truly know and understand what was wrong with the patient and thereby provide assistance. His treatment included using love, compassion and humour.
http://www.patchadams.org/   

Book is now published and available on Amazon

Well its been years in the making but the book has finally arrived. Available for download at just $0.99c from Amazon.com. Click on the little rotating widget on the sidebar to find it. Print version to follow. To keep the price of the book down I am printing in B&W only. Photos will be available on the website and facebook page (see links in sidebar). Happy reading!

Lady Luck

It never fails to amaze me how some people involved in serious motorvehicle accidents manage to escape relatively unharmed.

I have lost count of the number of accidents I have been called to where the vehicle was wrecked but the patient was somehow pretty much injury free.

The very first one involved a car that somehow went off the road into a ditch, coming to a sudden halt at the bank at the end of the ditch in a head on collision. The driver was knocked out and flung sideways. When I looked in the drivers compartment the steering wheel was up against the seat. He would have likely died from chest injuries. Instead he somehow got flung sideways out of the way!

More recently I went to a van with 7 passengers which rolled on a country road. One of the passengers had a hand injury but the rest walked away pretty much unharmed. No head injuries, no c spine injuries. Nothing!

Anotherone involved a driver who most likely fell asleep at the wheel and rolled his car on a bend on another country road.

When I pulled up the car was upside down and his legs were poking out from the passengers door. I immediately thought this was going to be a fatal but as I walked over to the car he wiggled out and stood up  He had been looking for his mobile phone!! Once again he was unharmed and refused to come with us so he went to the police station for a breath test instead!!

Yes Lady luck was shining on these people.

Everything is going to be ok

I just watched an episode of Rescue 1 which follows a rescue helicopter crew to jobs. The Advanced Paramedic had responded to pick up a rugby player with a suspected neck injury. The patient had been packaged onto a stretcher with stiff neck in place. He was lying there with a worried look on his face.

The Advanced paramedic leaned over him and put a hand on him and uttered those magic words. "Everything is going to be ok"

He went on to explain what had happened, why they had packaged him that way and what was going to happen next. 

Why am I making a big deal about this?

Because I have been a patient and I know how terrifying it is lying there imagining all the terrible things that you think is happening or going to happen to you. Your lack of knowledge or understanding, even as a clinician, results in you thinking the very worse and fear can really overtake you.

Hearing those words of absolute reassurance that everything is going to be ok from the ER doctor simply melted away all my fear.

As paramedics we often attend the same types of jobs over and over again. Chest pain patients for example become a routine call out for many of us, yet for most of these patients it is their first ever cardiac event and something that is probably very terrifying. Its hard not to think the worst possible scenraio when your heart is the source of your illness. Even worse, there is a general misconception that heart attack=cardiac arrest/death (which is only sometimes true!)

Yet how many of these routine patients do we attend to and forget to include in our standard treatment regime some simple reassurance of the patient that everything is going to be ok?

It is probably one of the single most effective parts of our treatments. Alleviating fear reduces heart rates which in turn reduces myocardial oxygen demand so not only does it have psychological effects, it also has positive physiological effects.

Now it may well be true that the patient is very ill and my deteriorate but the fact is, while they are in our care we have all the tools to help them, so for the patients benefit everything will be ok and they need to know this.

So next time you attend that patient and are busy sticking IV's in them, hooking them up to your monitor, taking their blood pressure and sticking an oxygen mask on their face, dont forget those magic words.....everything is going to be ok. Trust me, your patient will thank you for it.

Drugs and Patients

Recreational drugs get a bad rap in the press mainly because there are some nasty ones out there which can create havoc in the wrong individual (or even the right one).

Recreational drugs basically fall into two categories - uppers and downers although there are subcategories in each of these.

I remember when party pills first came on the scene in NZ. It arrived with the rave scene. Before its arrival we were guarenteed to go to alcohol fuelled assualts, drunk drivers, beatings or PFO's (Pissed and fell over) and the occasional riot every Thursday, Friday and Saturday night without fail.

When the recreational party pills came on the scene this largely dissappeared. We were all intrigued by it. Suddenly we were going to overdoses of a substance we knew nothing about. The patients, instead of being violent, aggressive and vomiting all over the place were usually sedated or spaced out but usually compliant.

Fast forward 12 months and the groups using these drugs had gotten used to how they worked and that it wasnt a good idea to either mix the drugs or take them with alcohol. As a result our call rates to drunk, aggressive, assaulted and PFO patients on Thursday, Friday and Saturday night significantly dropped off.

Even the Police noticed a change. At a large party event they would stage the usual nunbers of police with the paddy wagon at the ready. They soon realised that the mood enhancing drugs put people is a good mood instead of an agressive one and eventually the Police stopped attending the smaller raves altogether.

Then along came the legal 'herbal' highs. Once again we had the few who experimented and overdosed but after a while we had few callouts to these legal pill poppers.

Unfortunately the gangs realised the money to be made from recreational party drugs and started importing and suppling more lethal drugs. P, E, Meth even Heroin soon made its way to the streets and the occassional nutter that took them ended up creating havoc which made the national headlines.

Politicians, seeing this as an opportunity to boost their ratings jumped on the moral bandwagon and publically damned these 'evil drugs' and insisting that all party drugs be made illegal including the herbal ones. They seemed to ignore the fact that alcohol had created far more chaos and cost the country huge amounts of dollars in rehab and healthcare expenditure or that they had closed our psychiatric institutions and put the mentally unstable in the community with little supervision or support.

As a result the legal BZP containing herbal party pills were banned. The youth soon turned back to what they used to use - alcohol and underground drugs (E, P, Dope) and Thursday, Friday and Saturday nights have gone back to booze fuelled bashings, drunk drivers, PFO's and the occasional riots. Not only that, the government lowered the legal drinking age and allowed the increase accessibility of alcohol which fuelled the problem.

The reality is that people will always seek an escape from reality. Personally I would rather see people taking regulated, legal herbal highs than alcohol. I have yet to go to a party pill popper who as a result of taking a herbal high turned around and gave his Mrs the bash, or got into car and smack into an innocent victim or become super aggressive when they fall over and get peeled off the pavement. Alcohol on the other hand does all of this on a regular basis.

Thanks to politicians and their alter motives, they can safely sit back and sip on their malt whisky while our crews and emergency departments fill up again with vomit covered drunks, aggressive intoxicated patients and their assault victims and the occasional nutter who trips out on some underground illegal substance.

Thanks for making our job that much harder!!

Well thats my take on it. Be interested to hear your views.

Priority One Driving

Priority One Driving is when you drive fast with your lights and sirens going. It is used when the job you are attending is deemed urgent by the control room. They decided this based on the information they receive.

Unfortunately some people think this is a free license to drive wrecklessly and see what limits the vehicle can handle on the road. I have seen some absolutely shocking P1 driving, mainly from the Police. Once I was almost taken out by a Police car which came to a handbrake slide stop at an accident I was at. They literally stopped 1 ft away from me. If Joe public did this they would be arrested and charged with wreckless driving but because its the Police they seem to be immune.

Its a funny thing but there seems to be a direct link for some people between turning on the lights and siren and switching on a speed demon channel in that persons head. They become this completely different person who think they are totally invinsible and immune from danger. They transform to a racing car driver who's main aim is to drive as fast and wrecklessly as they can, wheelspins included. Its actually quite frightening sitting next to them.

Now I, along with most other people that drive emergency service vehicles, love driving prioity one, but I tend to do so with resepct for other road users and do it with the main aim of arriving at the job safely. Crashing an emergency vehicle on the way to a call is definately not a cool thing to do and although it happens a lot less than it used to, it does still happen.

The vehicles are so much safer to drive these days with ABS brakes, air bags, power steering, uprated suspension and even stability control and I suspect this has had a lot to do with the crash rate being lower than before rather than less people driving wrecklessly.

Below was a video I shot of some Police cars driving down Auckands Queen St. This is an example of some good, safe P1 driving. They read the road ahead (and avoid crashing into a bus that does not see them until he goes around the corner), do not drive excessively fast for the conditions and even stop at the red traffic light to make sure everyone has seen them before proceeding! Most importantly, they arrived safely at their destination!

Paramedic Registration - Good or Bad?

It seems inevitable that paramedics will eventually become registered practitioners when the registration process is implimented. Australia is lobbying hard for it as is the NZ Ambulance board. So will registration be a good or bad thing? Here are the pro's and Con's as I see it.

Pro's:

• Your qualification will be more internationally recognised / portable
• Increased public awareness of a paramedic qualification
• Standardisation of skill sets nationally
• Potentional increase in skills
• Less influence from any single Medical Director on protocols
• Skill sets should be based on best practice from panel of experts
• Right to practice will not necessarily be dictated by an ambulance service
• In theory should lift level of expertise in the industry 
• Should be a fairer system in deciding right to practice (less subjective)
• Rogue practitioners will be weeded out
• Broader opportunities for employment across the sector
• We get to wear another pretty badge

Con's

• WAY more personal accountability (not everyone ready for this)
• We will have to pay for the priveledge to do something that currently costs us nothing
• We will need to provide annual proof of practice which may mean relying on an ambulance provider to employ us (unless this is broadened to include other medical practice)
• Legal accountability will fall on individuals and not Medical Director as it does now
• Consequences of mistakes are far more serious and may result in suspension of registration during investigation instead of being delat with 'in-house'
• We currently rely on a large proportion of volunteers who may not want the responsibility of being registered and result in decrease numbers of volunteers
• The cost of registration may not be met by employers particularly for casual employees
• Unsure how an appeal process would work if board decision does not seem fair
•  False accusations or complaints from patients resulting in board investigations could ruin a career

Obviously this is not an exhaustive list and just my thoughts. Im not sure NZ is ready for registration yet and we have a long way to go to prepare for it. It would appear however that registration is coming whether we like it or not.


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Taking ownership of your health

It saddens me that many elderly people simply surrender ownership and responsibility of their health to our so called medical professionals. It would appear that very few doctors are willing to actually look into the cause of illness and actually treat it. Instead they seem intent on reducing symptoms by prescribing drugs and then more drugs to reduce symptoms caused by the first lot of drugs. For instance, many elderly patients (and adults in general) are chronically dehydrated, yet so many are on diuretics. This can lead to other issues which are then treated by yet more drugs. The pharmaceutical industry must love it. How many doctors actually enquire about the state of hydration and nutrition of their elderly patients, which can be the cause (or cure) for many ailments? Instead they reach for the pen, write a script and increase the profits of pharmaceutical companies. Thanks goodness for the internet and freedom of information :)

Sensational media

Another case of sensationalisation from the media. Went to a car v truck. Driver of said car had to be cut out and the fire service did an awesome job of cutting off the roof and door so we could extricate. Along comes newspaper photographer who reports that the crash was so violent that the roof and door flew off and were lying meters away from the crash. lol.

Imgae courtesy of Hawkes Bay Times

Air ambulance

AW139 Ambulance. Lots of room and no traffic lights to negotiate. Medivacs are great when you have a stable patient :)

Being able to give IV pain relief really is the most wonderful thing. Relieving suffering has to be one of the most satisfying feelings even if its just while they are in our care.

Today we are more spoilt than ever with two inhalation analgesics, three intravenous analgesics and an oral analgesic. It always makes my day when I can take someones pain away :)

We live in a topsy turvy world

I have come to realise that the world we see is actually inverted. The health system is actually not interested in health but sickness. Imagine if people were actually well and didnt need drugs, hospitals, surgery, doctors, nurses...there would be a lot of unemployed people and broke business's. Im sure thats why holistic and natural medicine is on the outer. It looks to fix the problem and create a cure rather than just treating symptoms and making people dependent on the system (think long term medications, hospital follow ups, ongoing surgery etc).

Even the supporting societies are not there to help but to maintain the status quo. Hence the Asthma Society is not actually interested in curing asthma - they would cease to exist. Same with the Cancer Society, Arthitis foundation, Heart Foundation etc. I read of a woman who found a natural cure for her arthritis after suffering in agony for 30 years. Delighted, she contacted the arthritis foundation, which she had been an active member of, only to be told they were not interested in hearing about her miraculous cure. I also find it interesting that Cancer charities who raise millions of dollars towards research and supporting cancer sufferers never seem to mention the simple fact that cancer cant survive in an alkaline environment which can be bought about simply through dietry changes.

But it doesnt just stop in the Health area. Police are not there to protect us against crime. If there were no crime there would be no need for a police force. They have a vested interest in the very existence of crime. Imagine if there were no burgularlies anymore. What would the giant insurance companies do? They dont mind paying out on claims becuase it gives them repreat business.

Governments are not there to represent the people anymore(their orginal pupose). They now represent the giant corporations and try and to control the people instead of answering to them.

I think finding out that Santa wasnt real was just the beggining of discovering that the world is actually nothing of what you think its about.

Still, knowledge is power, and armed with this knowledge I know I can now make a real difference.

A breath of fresh air

I worked with a veteran paramedic the other day. He has been doing the job for 30 years, yet he still enjoyed the job and was great to his patients. He had excellent clinical skills and was a really great teacher / mentor. I told him he had a great attitude and that if only we had more people like him the place would be all the better for it. He said it was a personal choice. Working with him was a total breath of fresh air and an inspiration.

Energy Theft

Ive come to realise the reason why emergency services get burnt out. Well this is my theory anyway. I believe we are all essentially energy beings - that is we have, emit and receive energy. Now, as paramedics we almost exclusively attend people who are giving off negative energy, or at the very least absorbing our positive enrgy. Everyone we attend is sick or injured. Their energy levels are sometimes very low, or in the case of dead people, non existing. Everyone knows about the attraction of oppossites. If there is an extrememly negetive energy present and you have positive energy, the forces try to balancel. Your energy is slowly eekked out of you with everyone you attend. At the end of a shift you are severely depleted. Add to this the often negative forces applied down on you from the management and you have a certain formula for burnout and job dis-sattisfaction.

Well thats my theory anyway :)

The body is a temple

It always amazes me that although we are all cognatively aware that we only have one body that we dont tend to take the best car eof it we possibly can. Almost all dis-eases come from an abuse of the body or mind through poor nutrition, lack of exercise, or a toxic environment (smoking, drugs, negativity, self imposed stress). And when dis-ease does overtake us we (in the western world anyway) expect doctors and the pharmaceutical industry to fix everything up. I am not saying I am any better. In fact it is only this last few years that this has all dawned on me and only now am I addressing my nutitional, cardiovascular and mind/spiritual wellbeing. I guess I take expect anyone else to look after themselves if I dont set an example as a healthcare provider.

Humour me

I learnt the hard way that humour, while fine with most patients to try and put them at ease, is not to be used with young patients who are drunk or high or with psychiatric patients. While trying to make light of the situation involving a 22 yo female who was tripping on e, her friend took complete offence and let me know about it saying she didnt find it amusing that I was making fun of the situation. Actually I was outside trying to gather info while my two colleagues were attending to her friend in the ambulance. Ended up telling the friend thats what happens when you accepts unknown pills from unknown people.

The used paramedic. A fictionional short story

I’m not sure what triggered it.

It could have been the car accident with the teenager whose face was half missing. A look of horror etched into the half that was still there as she saw the truck screaming towards her side of the car.

Perhaps it was the young lady whose hair, dangling out the back of her helmet got caught in the engine of the go-cart she was driving, tearing her scalp right off her head. I often have a vision of her sitting there in a chair, pale, swaying, her bloodied scalp bare for all to see.

Or perhaps it was the distraught mother who fainted while bathing her newborn baby, letting her slip beneath the water and woke to find it drowned. God knows we did all we could but the odds were just stacked against us.

No, thinking back, there is no one particular job that really made the difference. I think it was more the fact that after seeing twenty years of death, sadness, self mutilation and sickness it just accumulated, like a leaking tap, filling my emotional reservoir until it couldn’t take any more in.

In some ways I guess I’m not surprised it happened. Although completely out of character for me (well that’s what all my colleagues said), I had simply just had enough.

It’s not like I was like that all the time though. Hey, I was just as enthusiastic as the others to start with. I did my time at the bottom. Keen as mustard, volunteering whenever I could. Attending events no body else could be bothered doing. Doing extra shifts. Pulling my weight.

There were many good times as well. The close knit comradre. The sports teams. The daily practical jokes we would play on each other to release the tension. The black humour spilling out at any opportunity. The nineteen good years I gave everything to the job. Even my marriage in the end.

I guess when you are not taught how to cope with the stress you just do the best you can. This is not a job for whimps after all.

It’s been seven years since I left. That fateful day. That dreaded last shift when I snapped. I just couldn’t face going out on another call. I don’t know why my mind chose that moment in time to throw such a tantrum. Im pretty shocked and embarrassed by it all now but the professionals said it wasn’t uncommon for someone suffering post traumatic stress syndrome to behave like this.

I miss the job. I was good at what I did. I enjoyed it. Is it my fault that my human frailty caused me to react the way I did? It seems so unfair. Like all the effort I put in for so long counted for nothing in the end. The counsellor said I shouldn't blame myself for what happened. Accumulated stress she called it. I just wish my employer saw it like that too.

Its no use now though. That one moment in my career has tarnished me forever. A black mark against my name. ‘Do not re-employ’ stamped on my file. All that experience wasted. Thrown on the garbage heap like an empty drink container.

I suppose I shouldn’t complain. I saw it happen enough times to others. The supposed caring organisation we worked for shafting people when it suited. When their use by date was past it. The lucky ones managed to hang on. Slipping into PTS until their retirement.

At least I have some great memories and the knowledge that I helped so many in their time of need. Saved a few lives too. Seems so ironic really, going to so many dying people. One day it will be me.

In the meantime I carry on. Life goes on. The cycle will continue and staff will continue to pay the price for their dedication. At least I can say, for the most part, it was job I was really proud to do and I dedicated my life to saving others. I just wish I could still do it.

Top 5 tips for surviving in an ambulance service

1. Be nice to everyone you work with. Someday they may be your boss even if they did start 10 years after you!!

2. Check your truck off properly. Yes its boring as hell but its actually surprising what you find. Last check I found 8 pairs of safety glasses (there was only supposed to be 2) and most of the supposedly sterile needles had torn packaging (something to do with people trying to jam 10 of them under the elastic tie in the IV kit)

3. Your patient report form is going to get sent back to you cause someone else is determined to find something on it that you missed out or didn't write an entire chapter about. Just accept this as a given and remember point one above.

4. Sometimes you are going to be called an ambulance driver. Does it really matter. Just smile and nod. After-all it is 50% of our job isn't it?

5. If you are going to leave a patient at home at least make them feel like they got their monies worth. Measuring their SpO2, HR, BP while nodding and saying uh huh lots is a good start.

6. Remember that what a patient tells you on the way to hospital and what they tell the triage nurse are often two different things. At some point in time this is going to make you look really stupid at the hospital. But don't worry everyone goes through it at least a dozen times.

7. Stay calm at all times, or at least look like you are calm even when secretly your thinking WTF is wrong with this person or you have come across a major incident. Refer to the second half of point 5 is a good start.

8. Patients are customers. What's your Customer Service like?

9. Take up a hobby, study or something you can fall back on when you are burnt out and need to take a break. Its gonna happen so be prepared.

10. If you are burnt out do everyone a favour and take 12 months leave. You will feel much better for it and so will everyone else.