Life of a Trainee Paramedic

I spent half a day in Ambulance control yesterday to see how everything works over there and I had quite a good day. Luckily, my mentor’s crewmate’s girlfriend works up there so she was able to arrange it for me.  It was actually quite a quiet day, which the people who work there attribute that to the bank holiday being a wash out.

I started off listening to the calls that were coming in, and how they were dealt with.  I would have said that around 1/3 of the ones that I listened to were from NHS Direct, and the majority of them seemed to be valid reasons for calling.  When a call originally comes in, it’s the Operator who gives the number where the call is being made from, and then it it passed over to control.  This number’s address then shows up on the screen to be confirmed by the caller if that is where the emergency is.  It is not taken as a given because someone could be ringing for a friend who isn’t perhaps able to get to the phone.  The nature of the emergency is then asked, along with a few additional questions to decide best what category to assign the call.  It should be noted that while these questions are being asked, it does not delay an ambulance being assigned (if available).  Once the address has been confirmed, it then goes over to the dispatchers, direct the ambulance while the additional questions are being asked.  This makes sense as then an Ambulance can already be on the way to the scene while the additional details are being collected.

I then went over to the first responder desk. because the county in which I work, has one of the biggest first responder groups in the country.  The controller can listen in to the incoming 999 calls, and then can dispatch a first responder if there is one available in the area.  They don’t bother if they know an ambulance is not far away, and they can also mobilise some retained fire fighters, who have to live within 4 minutes travel time of the station, and can be sent to calls if there is no other immediate help.  this desk can also be used to take 999 calls if it gets extremely busy.  This is because of the ‘Call Connect’ targets laid down by the Government which means every 999 call has to be answered within 5 secs, and they have to achieve a certain percentage.  However they don’t really like to do this as it delays the dispatch of any first responders in the area, due to the call taker being otherwise occupied.

I finished off looking at dispatch and how that all worked.  On the several screen’s, you have all the ambulance that are assigned to the stations in their area.  The county is split up into 3 sections to make it easier to maintain cover, or that is the plan.  Different colours indicate the different status of the ambulances.  Green = available, yellow = en-route to standby, and red = attending an emergency.  All the ambulance should hopefully show up on the map that is on one of the screens, and there is also a list of the jobs that have just come in and a timer to show how much time has elapsed.  The dispatcher is the crew’s main point of contact at control, except if the radio’s a bit busy and they have to ring in, in which case anyone can answer the phones.

The people in control think that that most of the road staff hate them, because they think that when they send them a job, the road crew’s may believe there being shafted when they were nearly back to base.  Now I’m not saying that this would never happen, but the people that I met were all nice people and I believe that they wouldn’t do it on purpose.

I’m in work tomorrow, and then I’m off until next week as I am going to Hamburg for a stag do at the weekend, which will no doubt be fun!

TP

I was back in Uni today to redo my Trauma scenario, and I’m glad to say that I passed this time, although I did get my hands slapped by one of the lecturers for doing something today that I didn’t do yesterday! I stupidly rolled the patient onto their injured side, although if it was a real rugby player, I would have got a punch in the nose, or my crew-mate would have said something before I did it.  I knew what I had done when I went back in to find out how I did, and thankfully didn’t fail for doing it.  Some hard work ahead now for till Thursday with my portfolio.  I have a day in Control on Sunday although I doubt it will take all day, and then I have a day placement on Tuesday.  Should go quick, and now I have the Internet in my room, I can actually listen to the radio over the net rather than listening to the same CD’s over and over again. although it does have an annoying habit of choosing when to work or not!

TP

Well overall today, we had 9 separate exams.  I passed 8 of them with the resit for the one I failed tomorrow.  I will explain each exam in more detail and what we had to do for each.

My first exam for the day was regarding the oxygen cylinders that we carry.  We had to learn the safety aspects regarding oxygen and the safe use of the cylinder, what can cause problems, check for damage and how to correctly change the cylinders.  In my service the oxygen cylinders have simple connector valves, however at Uni we had to use ones where you unscrewed the connector off and then onto a new cylinder.  We then had to be able to identify different oxygen masks and there uses, and there are really only a few to learn.

Oxygen = Pass

The next scenario was the ‘Paramedic Assist’ exam, which I explained about in a previous post.  There was two 2nd year students there acting as a paramedic and a first responder.  They concentrated on doing all the CPR while I got the equipment ready that the ‘Paramedic’ had requested.  As long as you did everything ok, or if something went wrong, you said what you would to do rectify it, then it wouldn’t be a problem.  For example, when I was setting some fluid’s up, I had an air bubble in the tube, and rather than let it leak all over the floor, I just said that I would drain it before attaching it to the patient.  When on placement, I usually just run a bit off out the back door if there are any air bubbles.

Paramedic Assist = Pass

The next scenario was regarding Entonox, which is a gaseous drug that is given to relieve moderate to severe pain.  Women who have given birth may have had it, and it’s also known as laughing gas.  We went through the safety implications again and we also had to talk about the indications’s for its use and the caution’s and contra-indications that are associated with it.

Entonox = Pass

The next scenario was the one that I was dreading the most, and it proved to be poetic.  This was the trauma scenario and we were presented with a 22 year old male who had been playing rugby and during a ruck, it collapsed with him at the bottom of the pile.  We had to assess his injuries head to toe, and treat him the best way we could.  He was complaining of neck pain so I got my ‘colleague’ to immobilise his C-Spine.  This is the area of the spine at the back of the neck.  What I should have done next was to put a collar on him, however TP’s mind went racing off somewhere else and I did not do this until later on in the scenario, which was much to late.  I had also done a hap-hazard primary assessment, then to secondary and then back to primary again, when I should have really started from the top down.  He had sustained ‘injuries’ to the upper right quadrant of his abdomen and his right shoulder, yet I went to his limbs before I chose to expose his chest to assess him.  I think my communication was good, I talked to the patient throughout and gained a history of the bystanders who had ‘witnessed’ the incident.  With one or two other things added in, it should go ok.  I have to go back to Uni tomorrow to redo it which wouldn’t be so bad if I didn’t live 1.5hours away.  It can’t be helped however.

Trauma = Fail

We then had an MCQ paper on the computer regarding 3 drugs.  These are Salbutamol (Ventolin), Ipratropium (Atrovent) and Adrenaline (in regards to Anaphylaxis).  It was out of 24 and we had to get 19 to pass.  I managed to get 23/24.  We had already had this test a few months ago, where I got 21/24 so I wasn’t to sure why we had to do it again, not that we had any choice in the matter.

Drugs Test = Pass

We then had a little break before my next scenario was another ‘big’ scenario, much like the trauma one except more medically related.  This involved a 50 year old female who had not been seen for a few days and when I went in and assessed was found to have a blood glucose level of 1.2 milli moles.  The normal level should be around 5-7.  This made me suspect that this patient was having a hypoglycaemic attack.  It was not clear at this stage whether the patient was a diabetic as they were very unresponsive.  There was however a bottleof ‘vodka’ on the side and alcohol can actually cause hypoglycaemia and lessen the effects of some treatments.  We had to decide what treatment’s to give her which was only Glucose gel (dextrose 40%) and glucagon.  We could not give glucose 10% as we were acting as technicians.  We had to simulate on a manikin bottom where we would give the glucagon (dextrose cannot be given to patient’s with a low level of consciousness)

Medical = Pass

I then had 2 quickfire paediatric resus scenario’s involving a baby and a child and the procedures that are followed (or attempted to be followed) as given by the resuscitation council’s latest guidelines.

Paeds Resus = Pass

The last scenario forme was Intermediate Life Support, which is adult basic life support but with the use of a defibrillator.  There was a first responder on scene who was already performing compressions and we had to attach the pad’s from the defib and assess the rhythm to decide whether to shock or not.

ILS = Pass 

Overall it was a good day, I can hardly complain after passing most of them.  Hopefully tomorrow will go fine, and then there won’t be that much left to do. 

Have a good weekend!

TP

The countdown has begun until my exams.  It’s T-Minus 10 hours from this point until they begin.  I think I’ve prepared myself well enough but we shall see when the time comes.  I just hope there are not any road closures or accident’s on my way into Uni.  Now that would be unfortunate!

 TP

We had our last 2 pre-exam days last week on Thursday and Friday, and they were a lot better than the week before.  They seemed to be a lot more relaxed and most people seemed to be more confident in what they were doing.  Before we got started on the Thursday, the lecturer dropped the bombshell that we could have one of our essay marks back.  This was a 3000 word essay, unlike the last one which was 1500, and having not done to good, I was a little nervous about this one.  Thankfully I got 65% which I was really pleased about.  If I had got that last year at Chester I would have been very happy so I had no reason not to be this time. 

We then started to go through some of the scenario’s that we are going to be doing.  The ‘Paramedic Assist’ scenario which scared the life out of everyone the week before was done with the lecturer who is actually going to be doing it for our exams and it was totally different.  Where last week we had to tell the Paramedic when we wanted them to intubate or cannulate, which we would never do, this week we did was in the title, ‘assist’!  We had a go at the ‘Medical’ and ‘Trauma’ scenario’s again, and the trauma one threw us the most.  We found one of our lecturers lying face down on some stairs and we had to figure out what to do.  Due to his awkward position, we got distracted by that and didn’t concentrate as much as we should have on actually assessing the patient, so needless to say we failed on that one but we can hopefully learn from our mistakes in that area.

On Thursday afternoon, after we had finished practising the scenario’s we had a meeting with the service education big wigs.  They wanted to get out feedback on the course and how we felt our placement was going.  There were a few issues raised by some of my colleagues but overall it went well.  However due to the range and number of jobs that some people experience on their stations, the service suggested that they may move some of us to a rural and urban station for next year.  This idea went down like a lead balloon for those of us who are happy where are are.  It’s taken time for us to build a relationship with our mentor’s and gain their trust and we don’t want to have to waste time doing this all over again.  We shall see what happens on that score!  

On Friday morning, we had our ECG test, which consisted of 12 example rhythms and we had to identify them and assess whether they were shock-able or not.  We also got the results back from our exams we took at the end of February, and thankfully I passed them.  I thought I may have failed on the written exam’s but I managed to get better marks than the actual assessments.  So hopefully I will manage to pass everything this week, and then all that is left is my portfolio which is in for the 31st May and then all Uni work will be done for the year and I can just enjoy placement.

Next month is going to be a quite busy one with a stag do, which I have just found out is going to be in Hamburg, then my parent’s 25th the weekend after and then the wedding of the stag do at the end of the month.  So I’m going to be doing the journey home a lot over the next month.  Thankfully, for the 1st time ever, my car passed it’s MOT first time, and my insurance has come down a good whack which will please my bank balance.  The next few days are filled with revision and portfolio writing and then we have the exams on Thursday, so lots to be done until then.

TP

The past few shifts have not really had that many jobs of note.  They have been very steady with not that much break in between.  Luckily when I’m on nights, although on the first night I usually get tired around 4am, the rest are not that bad.  This is perhaps because I can sleep until 4-5pm if I’m lucky, so when it gets round to early morning time, I’m wide awake.  This is good when there are jobs coming in, but when your out on standby, and try as I may, I cannot do any reading that early in the morning, I find it hard to have a little shut eye.  If I get up earlier in the day, by the time I get tired, the colour has all drained from my face and it takes me a while to get going again. So I can’t win.  I like night’s though as you can sleep for as long as you like, where as on days you have to get up at a certain time.  I’m lucky that my shifts start at 6.45am, unlike some of my colleagues in another trust whose shifts sometimes start at 6am!  One of them told me that they had to get up at 4.10am to get there.  That would absolutely kill me.

My last shift I enjoyed the most though because there was a lot more patient care involved.  As I’m based in a city, there is not a great deal of journey time to the hospital, so by the time you’ve filled in the patient form, were at hospital.  This shift however, we had a transfer to a hospital that was 1 hour 20 minutes away.  The patient had sliced open all the fingers on his left hang by a circular saw while cutting some wood.  There was nothing medical to be done, just transport the patient to the receiving hospital.  The patient said originally when we were wheeling him out of A&E that he would probably sleep the whole way, but we ended up talking for the lot of it.  He had recently moved up to my area, but had come from an area which isn’t that far from where my home is so we got chatting about that and all sorts of things.  I really enjoyed it as it was my first chance to just chat like this.  I know that some patient’s will not be like this, they could be quite happy not to talk, or may not want to, but it went quick. 

Later on in the shift, we were called to an 83yr old lady who had fallen and couldn’t get back up.  We had to break the chain on her door to get in and found her lying face down on the floor.  She was checked over for any fractures before we moved her and we got her into her chair.  She didn’t really want to go to hospital, but we were not happy to leave her there on her own as her mobility was severely impaired so we made a deal with her that if she could get to her room without any assistance from us, then we would leave her.  She was unable to even lift herself out the chair so she agreed to go to hospital.  It was also my first chance to actually call a patient’s relative to inform her of what we were doing.  The journey to hospital would take about 20 minutes and I sat chatting to her the whole way there as well.  She told me about her children, how she used to be in the RAF in the war and was a very good ex-ballroom dancer.  Her being 83, and me 21, I was still interested in what she had to say, not just feigning it because of my job and had a good time talking to her.

These two jobs have hopefully helped me to fulfill one our learning outcomes for the portfolio ‘Outline the role of the paramedic in the care of the non-emergency patient’, and I think these two examples fit it perfectly.  Now I just need to get on and write that……

 TP

The last two days I’ve spent at Uni with the other students preparing for our exams. there termed OSCEs which I finally found out means ‘Objective Structured Clinical Examination’.  Why they cannot just call them exam’s I don’t know.  They will involve around 8 or 9 ’stations’ where there is a different situation in each, with two of them being computer based.  We have an ECG rhythm test, an MCQ paper of the drugs for asthma and anaphylaxis (which we have already done a few months ago, but they want to give it us again), a medical scenario, a paramedic assist scenario, Intermediate and paediatric life support scenario’s, a test on the uses of oxygen and entonox plus a trauma scenario.

The paramedic assist scenario involves us finding a patient collapsed on the floor who as no breathing and we have to start CPR.  After the 5th cycle of CPR, and after we’ve checked the rhythm on the defib, a ‘Paramedic’ and ‘First Responder’ arrives to assist.  We give a description of the situation and ask them to take over the CPR while you can start getting the equipment ready.  We have to be able to show that we can assist with intubation, cannulation and setting fluids up by getting all the equipment ourselves and handing it over. We have to keep an eye on the time as there is a 15min time limit, but we also have to be aware of how many cycles of CPR there have been.  After every 5 cycles of CPR, you have to recheck the heart’s rhythm and determine whether it is shockable or not.  If it is, we do so, and if not then CPR is resumed for another 5 cycles.  It was our first attempt at this scenario and it was very hard to try and remember everything and to get it done quickly.  A lot of us wondered why we hadn’t done this scenario before so that we could have more practice before our exams which are in less than two weeks.

The medical scenario we think is going to involve a diabetic and the drugs associated with that.  How we assess and question the patient is also going to be marked so see if we can get a good and accurate history from the patient.  The ILS and paed’s life support scenario’s are just that,we us showing that we know the guidelines and what order to do things really.  We were supposed to be at Uni till 5 on both days but we ended up leaving around 2.30-3 because of staffing problems.  I was quite happy to leave then, but I would of stayed if I knew we were going to do something.  Some of my colleagues were less than impressed as they as they had arranged childcare for no reason, and it was annoying that the staffing situation couldn’t have been sorted before we got there, after all these dates have been known all year.  We have two days again next week practice, but were having the ECG test on friday morning to get it out of the way.  The test wil be 12 question’s long and we need to get at least an 80% pass rate so it which means when rounded we next to get 10/12.  To be honest I’m not anticipating it will be that hard, as long as we know what the rhythm’s look like and which rhythms are shockable or not, then it should be fine, but you never know.

At badminton this week I was talking to a lady who had suffered a serious accident 18 months ago being hit by a car at 70mph, when your a pedestrian.  She was in hospital for around 6 months and during that time contracted MRSA.  She made a point to me that it was very easy for bugs to pass round because of the simple thing of people sharing the magazines that they had bought or the exchange of money that comes from the tea trolley.  Magazines and money obviously don’t undergo disinfection procedures and was a very easy way for germs to pass from patient to patient.  How far though do we need to go to stop the spread of the germs.  Would you like being in hospital for a huge length of time without having anything to read and having something from the trolley.  I know everyone would want to get better, and not contract anything while in hospital, and these are only little examples, but how far really would it have to go? Who knows?

TP

I was tagged to do this MEME (whatever that mean’s) by Mr Man’s Wife so here it is, although a little shortened:

Three Things That Scare Me:

1. Snakes - Especially when they are wrapped round people’s necks and you don’t expect it.
2. Turbulence when flying
3. Death by Drowning   

 Three People Who Make Me Laugh:

1. My friends

2. My Family

3. Dame Edna

 Three Things I Love:

1. Haagen Daz’s -Pralines and Cream

2. Going on holiday

3. Spending time with friends and family

 Three Things I Hate:

1. Cheese

2. Stupid Drivers

3. Losing any type of game to my best friend.

 Three Things On My Desk:

1. My Phone

2. My Keys

3. Suprisingly my Uni Work.

 Three Things I Want To Do Before I Die:

1. Go into Space

2. Learn a Language (other than English)

3. Time Travel

 Three Things I Can Do:

1. Fold my tongue

2. Play the Keyboard

3. Count to 100 in French

 Three Things I Cannot Do:

1. The bloody Countdown Conundrum

2. Speak another language

3. Skate backwards on Ice Skates

 Three Things I’d Like To Learn:

1. Italian or possibly French

2. Sudoku

3. How to fly

 Three Favourite Foods:

1. Apple Crumble

2. Sunday Dinner (Any meat)

3. Home Made Meat and Potatoe Pie

 Three Shows I Watched As A Kid:

1. Thomas The Tank Engine

2. Thunderbirds

3. Teenage Mutant Ninja Turtles

 TP