Posted by: medicblog999 | December 15, 2009

Chest pain 10 out of 10. Day 2 on the Ambulance

CoEMS

Day two on the Ambulance started in the same way as the day before, straight off to the Ambulance depot to pick up our vehicle and our new partner for the day.

No Medic99 today, instead we were assigned to Medic44. Different call sign, same type of vehicle. Our partner was Kurt, who was a paramedic, the same as Justin, but with one special difference. He wore a Blue Paramedic badge and not a Red one.

Now this mean seem nothing special to most, but after talking to Kurt for a while, it became evident that he was actually quite proud to be wearing his Blue badge. This is worn by those who were paramedics before the merger with the SFFD. Kurt is a paramedic only; he has had some fire fighter training, but has not perused the option to become duel qualified. He works on the Ambulance every day and never does any engine shifts.

He was a completely different personality type from Jim yesterday, and at first, I wondered how this was going to go, as initially, I didn’t think he was too keen to be there with all of the cameras. He assured us, however, that he was ok with it, but was going to drive for the day to let Justin and I continue our filming for the shift.

Once the vehicle was checked, we headed off into the centre of San Francisco and down onto Embarcadero (which is the road right on the front of the bay area, where all of the piers are situated. We parked on post in front of the old Ferry Building which is now a pretty exclusive shopping and dining area, and went inside for a coffee and some breakfast. It was another beautiful day, and I quickly had a thought to the type of weather that will be waiting for Justin when he comes over to the UK the following week!

On post at Embarcadero

On post at Embarcadero

After we got our food and drinks we headed back to the Ambulance and waited for the first call to come in….

After about 10 minutes, we were dispatched Code 3, to a report of a female with abdo pain across the other side of town. We never got to that Job…….

Now, for those of you who were following along with our Tweets and daily videos whilst I was over there, you will remember us saying something about an incident that we could not blog about or share. Well, unfortunately this was the incident. I agreed along with everyone who was on the vehicle, not to blog about it, but all I can say is that we never got to the emergency and it is always important to wear your seat belts in the back of an ambulance travelling on lights and sirens through a busy city centre as we all know how dangerous and risky it is to weave through traffic on the way to a job.

If anything changes and we get permission to share, then rest assured, I will be the first one to write about it, but until then……Shhhhhhhh!

Anyway, following ‘the incident’, we had to go back to the depot, which is where we stayed for the next 60-90 minutes. Justin went off to check his emails and do a little work on the computer, whilst I stayed with Ted and Chris to do a little bit of filming.

After a short while Justin arrived back with us and we got to talking.

Medic999: “You know, a lot of what we have so far is serious stuff that shows what we are trying to do and the serious discussions that we have been having. I think we need some funny bits to offset the rest so that the program doesn’t become too ‘heavy’”

And then the plan was hatched and the ideas were formed. Then the filming took place.

Again, and I make no apologies for this one, I am not going into details here, and I aint gonna tell you anything about what we did for the next 30 minutes as it will spoil what you will see when the 1st episode of the Chronicles of EMS comes out. The only thing I will say is that we had a great laugh and hopefully you will enjoy our slightly ‘tongue in cheek’ view of American EMS as much as we enjoyed filming it.

Once we had finished back at the depot, it was straight back out on post, but we never got there this time. We were instead dispatched to a young child who had been locked in his mother’s car. Witnesses stated that he had been there for the last 3 hours whilst the mother had gone off and done some ‘shopping’.

As we got on scene the child was out of the car and was with the local police. Immediately, you could see that he was absolutely fine as it wasn’t a particularly hot day so hyperthermia wasn’t going to be a factor. From the discussions that Justin had with the police, it appears that this was absolutely no different from what we get in the UK numerous times during the week.

The police required an ambulance to ‘check out’ the patient. They all knew that he was fine, but they wanted a ‘professional’ to determine the need for medical treatment or not. I guess that is understandable to some extent, but it doesn’t make it any less frustrating. There were some language difficulties when speaking to the child’s mother, but thankfully, the young boy was able to interpret for the mother and it wasn’t long before she made it very clear that she didn’t want her child to go to hospital. Once Justin got reassurances that they were not going to be arresting the mother, we left the scene after getting the good ‘ol refusal of treatment, and left the patient and his mother in the care of the police to decide what was going to happen.

Not much of an exciting job, but it was still interesting to see the police and the SFFD working together and seeing that they apparently have a good working relationship too.

It was however, very weird to see the police all carrying side arms. That’s one thing that always looks odd to me; although I am sure it is only a matter of time before our police force eventually reverts to the same thing.

We cleared from scene and were sent on another post. This time just down the road from my new hotel.

IMGP1472compressed

More quality food and Ted on his iPhone....AGAIN!

Kurt stopped off for some lunch and we all piled out of the ambulance to try some authentic Mexican cuisine. Again, I’m not entirely sure what I was eating but it tasted good, and it was HUGE! I couldn’t even finish it, which for me, is practically unheard off. We all had to laugh though when Ted walked in after us and order a Grande Burrito. We had all just got the standard ones, but they were still enormous. Ted took a quick glance at ours then decided to change his order to a regular too. Justin and I sat on the back step of the Ambulance, half way down Market Street, and ate our lunch. I know it was nothing glamorous, or exciting, but it was the moments like that one that I remember more than most things from the trip. Just being part of a crew and soaking up the atmosphere of being in the city and seeing the ‘real’ San Francisco.

We were just about finished when we were activated to a Cardiac Arrest.

As we travelled to the job, I was looking forward to seeing Justin and his colleagues ‘work’ an arrest. I am used to the frustrations of trying to resuscitate a patient with a maximum of only two other people, and usually just one to assist me. I was eager to see the difference that having 5 or 6 trained responders can make to a patients outcome.

As we pull up on scene, there is an Engine already there and the crew are upstairs in the patient’s residence. As I climb the stairs, I can hear no commotion, no monitors and no counting. Just quiet conversation.

The Engine Company have already decided not to resuscitate. The patient had been deceased far too long for anything to be done for her. Justin and the Medic from the Engine have a quick discussion and the decision is made for the Engine Medic to complete all of the documentation and free us up to be available for the next call.

The rest of the day was spent going from post to post, intermingled with a few standard calls to deal with. Nothing too different from what I would normally do each and every day at work.

We stopped at some scenic spots to do some filming when we got the chance too. As we were going through Golden Gate Park, I asked if we could pop to the Bridge, as I hadn’t seen it properly yet.

IMGP1454compressed

What would it be like to work here permanently?

We ended up in a lay-by, which provided a great view of the bridge in the distance, and a great backdrop for some more filming and some photos for my own personal collection. As we stood there looking out at the bridge, a certain thought came into my head…

“I wonder how hard it would be to come over here and work, permanently.”

However, I realised that I was just getting caught up in the moment, and gave myself a shake and put that particular thought to the back of my mind……for the time being.

No sooner had I brought myself back to reality, than we were sent back to earth with a bump.

Sent Code 3, for a cardiac chest pain, in the centre of the city, actually just next to where I sat on the step of the ambulance eating my Burrito just a couple of hours before.

We arrive to meet the ‘lovely’ Roxanne. The suspicious spider sense in my head starts to tingle when Justin asks the question

“So what appears to be the emergency?”

“I have chest pain, going into my neck, scored at 10 out of 10”

Now that to me, and Justin, screamed out ‘PROFESSIONAL PATIENT!”, however as we must do, Justin continued on with his assessment and did all of the things required for a cardiac patient. It appeared blatantly obvious that she just knew the magic words, and after Justin had gained media permissions from her to be filmed, he asked her if she had just called 911 to get an ambulance there quickly and to get a ride across town.

“Yup!”

All caught on film! Now that’s real EMS for you…

Unfortunately, Justin and Kurt could do nothing other than what she had requested, so we began our transfer to take her to the hospital as requested.

Maybe, I won’t go and work there after all. I can’t imagine that I would be able to deal with the frustration of not being able to tell ‘patients’ like Roxanne that they are not getting on my ambulance and I am not taking them to the hospital.

Once the handover took place at the hospital, we had a few minutes to chat to some of the other crews at the hospital. They again, were all keen to hear about what we were doing and loved the fact that we had Roxanne admitting her system abuse on film. The support for Chronicles of EMS seemed to be growing each and every day.

IMGP1520compressed

Shaun and I

I also had the opportunity to have a chat with Shaun, one of Kurt’s old work colleagues who used to be a paramedic, but got out and trained to be a physician’s assistant (like a nurse practitioner in the UK, I think). We had a great chat where he told me the reasons why he decided to leave the profession and how much he is enjoying what he is doing now. He seemed a very intelligent gentleman and was very settled in his role in the hospital. It looked like a natural progression to go from paramedic to an ER Physicians assistant, but I am not sure how easy or hard it actually is to achieve. If there was such a role or development opportunity like that for UK Paramedics, I would certainly be interested in looking into it, but alas, nothing around quite yet!

I was meant to have one more shift on the Ambulance in 4 days time, but due to some miscommunication, the opportunity was lost. I had nearly finished my two ambulance shifts with the SFFD…

We only had time for two more Jobs before the end of shift which I will share with you next time, along with my general thoughts and impressions on my two shifts on the Ambulance……….

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Responses

  1. Hmm sounds very much like you crashed the ambulance! Physicians assistant do exist over here but it involves going back to uni (such as Birmingham for 2 years) see – http://www.nhscareers.nhs.uk/details/Default.as… they seem to do a bit more then nurse practionairs.

  2. Physician assistants are rather different than nurse practitioners, at least the ones here. NPs are trained in the nursing model, while PAs have a medical model. It's a 2-year post-graduate degree, and PAs can work with limited supervision of a physician. They can diagnose disease and prescribe most medications (that varies by state).

  3. Hmm sounds very much like you crashed the ambulance! Physicians assistant do exist over here but it involves going back to uni (such as Birmingham for 2 years) see – http://www.nhscareers.nhs.uk/details/Default.as… they seem to do a bit more then nurse practionairs.

  4. Physician assistants are rather different than nurse practitioners, at least the ones here. NPs are trained in the nursing model, while PAs have a medical model. It's a 2-year post-graduate degree, and PAs can work with limited supervision of a physician. They can diagnose disease and prescribe most medications (that varies by state).

  5. Mark, it's quite validating to hear that you are just as frustrated with our system of pre-hospital care as we are. I'm almost certain that this defensive type of care is due mostly to the litigis society that we live in where everybody is looking to make a quick buck via lawsuit. I have found myself thinking differently over the last week or so when evaluating a patient as to their medical needs. Most complaints are questionable and would most certainly be better address by a PCP. However, I guess it's just my training that over-rides my general impressions, and given the choice I would have to err on the side of caution and transport. You have all the respect I can give for having the confidence and training that allows you to make a field determination for treatment. You sound like more of a physicians assistant than you may realize.

  6. Correct me if I'm wrong, but wouldn't an ECP be a logical progression for you? Unless that's your current role and I've misinterpreted it.

  7. Mark, it's quite validating to hear that you are just as frustrated with our system of pre-hospital care as we are. I'm almost certain that this defensive type of care is due mostly to the litigis society that we live in where everybody is looking to make a quick buck via lawsuit. I have found myself thinking differently over the last week or so when evaluating a patient as to their medical needs. Most complaints are questionable and would most certainly be better address by a PCP. However, I guess it's just my training that over-rides my general impressions, and given the choice I would have to err on the side of caution and transport. You have all the respect I can give for having the confidence and training that allows you to make a field determination for treatment. You sound like more of a physicians assistant than you may realize.

  8. Correct me if I'm wrong, but wouldn't an ECP be a logical progression for you? Unless that's your current role and I've misinterpreted it.

  9. Mark, it's quite validating to hear that you are just as frustrated with our system of pre-hospital care as we are. I'm almost certain that this defensive type of care is due mostly to the litigis society that we live in where everybody is looking to make a quick buck via lawsuit. I have found myself thinking differently over the last week or so when evaluating a patient as to their medical needs. Most complaints are questionable and would most certainly be better address by a PCP. However, I guess it's just my training that over-rides my general impressions, and given the choice I would have to err on the side of caution and transport. You have all the respect I can give for having the confidence and training that allows you to make a field determination for treatment. You sound like more of a physicians assistant than you may realize.

  10. Correct me if I'm wrong, but wouldn't an ECP be a logical progression for you? Unless that's your current role and I've misinterpreted it.

  11. Physician assistants are rather different than nurse practitioners, at least the ones here. NPs are trained in the nursing model, while PAs have a medical model. It's a 2-year post-graduate degree, and PAs can work with limited supervision of a physician. They can diagnose disease and prescribe most medications (that varies by state).

  12. Mark, it's quite validating to hear that you are just as frustrated with our system of pre-hospital care as we are. I'm almost certain that this defensive type of care is due mostly to the litigis society that we live in where everybody is looking to make a quick buck via lawsuit. I have found myself thinking differently over the last week or so when evaluating a patient as to their medical needs. Most complaints are questionable and would most certainly be better address by a PCP. However, I guess it's just my training that over-rides my general impressions, and given the choice I would have to err on the side of caution and transport. You have all the respect I can give for having the confidence and training that allows you to make a field determination for treatment. You sound like more of a physicians assistant than you may realize.

  13. Correct me if I'm wrong, but wouldn't an ECP be a logical progression for you? Unless that's your current role and I've misinterpreted it.


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