Posted by: medicblog999 | October 26, 2010

This is why I blog!

Sometimes, I get an email in the middle of the night which reminds me when I am at my most tired and exhausted, exactly why it is that I choose to spend a little extra time to blog and share my world with everyone else on the internet. This one came in last week and is reproduced with the kind permission of the sender

“Mr Glencorse (I feel rude calling you Mark since we don’t know each other!!),

Just wanted to drop you a quick email to thank you for taking the time to keep your blog running.

I’ve only just ventured into the EMS blogosphere over the last year or so and have tonight finished reading your archives from the very start, and have very much enjoyed your journey (save the slight mishap this year where  thought you had really finished, which made me very sad L).

For the last 18 months I have been working my way through the recruitment process for a position as a student paramedic after graduating and deciding that Fine Art is neither my forte nor my passion! I never knew what I wanted to do with my life and subsequently coasted through school and university with no real direction (I’m ashamed to say) – I made some rash decisions and had some pretty poor career advice and ended up heading in a direction that was not at all that I wanted and made me really unhappy. I’m not quite sure how I decided to apply to the ambulance service and can’t remember whether it was before or after I started reading blogs but they have definitely had a huge bearing on making the decision to put everything into my application!

Along with the support of my real life friends (or “fleshy friends” as I like to call them, hehe) who have taken me out on their ambulances, let me play with their toys and endlessly practiced grilling interviewing me, I have benefitted from those of you who are kind enough to share your calls, and more importantly your thoughts and feelings about those calls, so generously.

I had found it difficult to bring up some of the problems I have observed with pre-hospital care with the fleshy friends, being an outsider and not wanting to upset them or offend their loyalties to their services (or look stupid)! The blogosphere has fitted a nice little niche and provided a balanced outlook and discussion of many of these issues which has definitely helped me to understand the developing role of the Paramedic. Ultimately reading my little list of pre-hospital care blogs has played a big part in my career decisions, and the insight of such a variety of people that I have been able to share has certainly cemented my goals. I can’t forget to mention that I have also learnt a great deal about pre-hospital care itself from reading, although I’d be lying if I said I understood your ECG posts – that’s something I’ve still tog et my head round!

I recently passed the recruitment process for a UK Ambulance Service and was offered an immediate training date (which I was very proud of as it was competitive and I secretly thought I was an average applicant, I don’t mean to sound arrogant!) but turned down this course as I have also now passed all the stages of recruitment for another service (which is my local Ambulance service, and my employer of choice) and my application has been progressed to the pre-employment checking stage. I’ll have to see how that goes but even if this application doesn’t turn out as hoped I’ll not give up!

So my quick thank you sort of turned into a much longer thank you but I just wanted to tell you that even though you’ve achieved massive, global success with CoEMS and now Ambulance Matters and you clearly make a positive impact on all of your patients and their families, as well as your own family, that you have also inspired and motivated a disheartened girl (that you’ve never even met!) to get off her bottom and do something that matters if she works hard and will make her proud!! Thanks!! “

To the author of this email (you know who you are!), thank you so very much for taking the time to reach out and contact me. You made my night/day/week!

Advertisements
Posted by: medicblog999 | October 23, 2010

Does the delay matter?

As you are reading this blog and this post, I am going to assume a couple of things about you, the reader.

I assume that you are most likely in EMS or have a healthy interest in it.
I assume that you are pretty much committed to learning as much as possible about the care you give your patients.
I assume that you are well read and subscribe to the ethos of delivering evidence based practice.
I assume that you are clinically up to date, or at least striving to be.

I assume that you are still very much in the minority of EMS providers.

Thats not to say that everyone else is bad and well behind the times (although there are some out there like that), just that as a group of professionals, there are many who are happy to just potter on and do what is expected of them on a day to day level.

The publication earlier this week of the 2010 AHA and ERC Resuscitation guidelines was hotly anticipated by providers all over the world.We were looking forward to some potentially radical changes which could provide real and significant increases in the survivability of our patients from out of hospital cardiac arrest.

Many bloggers and podcasters have addressed the issues and changes that have come from the new guidelines. So much so, that I am going to side step doing just that in this instance.

What frustrates and annoys me is that as we are being asked to be more professional in our actions, more professional in our reading and studying; more professional in our application of knowledge into practice and more professional in our duties, that we still cannot command the respect from many others that we actually know what we are talking about and understand what we are reading.

I am aware that I cannot change my practice to the new Guidelines until they have gone through our clinical governing body, the Joint Royal College Liaison Committee, and then have been approved by our medical directors and then fed down to the operational staff. I accept that it would cause chaos to allow each paramedic, as an individual practitioner to implement the new guidelines when they have read and understood the rationale behind the changes and the impact that they may have. It was cause nothing but confusion and poor application of skills if you had a couple of medics at a cardiac arrest working off seperate guidelines and not knowing what they other is wanting.

I can see this taking quit some considerable time to filter through all the bureauocracy of the NHS before we can once again state that we are using the best and most up to date evidence based practice.

Tom Bouthillet asked a great question of Dr Kleinman on the recent edition of The Medic Cast podcast when he wondered what could be done to reduce the delay in time from the publication of the new guidelines to the implementation of them. That just goes to show that this is apparently a much bigger problem than just UK pre-hospital care.

Until I get the ok, I guess I will still be doing everything to the best of my ability but continuously hoping that someday soon, someone will say to go ahead and use the new guidelines. I know that it isnt a magic tablet to the disease of Cardiac Arrest, but personally, I just want to know that I am doing what is recognised as the best possible medicine for trying to return my patient to his or her family.

How is it for your service? Will you be implementing soon or will it take some time?

Posted by: medicblog999 | October 22, 2010

Working a Police Paramedic Shift – Part 2

For part one click here.

After we had cleared from the last job we again proceeded to continue on patrol around the town centre.

As the town is so close to one of the largest infantry training camps in Europe, when this team was being put together, Dave contacted the Garrison to ask for a Regimental Police Officer to be also part of the team.

On this night we had Jim with us, a formidable man fully decked out in his military combats with an impressive ‘MP’ badge (im sure thats not the right name for it) attached to his sleeve. As we drove around we would be looking out of he windows for anything suspicious or anyone who looked about to ‘kick off’. Dave and the other guys would regularly call out “squaddies” and point to a group of lads.

“how do you know they are squaddies then?” I asked, all innocent like.

Jim turns his head with a look of contempt…

“Just look at the haircuts”

Oh, of course.

We stopped a couple of times for the team to get out of the van and talk to a group of young soldiers to remind them of the pubs they are allowed in and those that they are not. There are a number of pubs and clubs that do not like to have a large number of soldiers turning up drunk, so rather than have confrontation at the doors, the agreements are already in place and the soldiers know where they can and cant go which seems to work well.

Later in the night as one of the pubs was starting to wind down, we noticed a group of soldiers from the Garrison gathering outside of the pub. It looked like a very confrontational situation so Dave pulled the van over right next to the group.

“Right Lads, thats enough! Settle down and start heading back to the base”

All that came back to Dave and his colleagues was a bunch of attitude and more than a couple of swear words. I was starting to think that this might turn a little nasty when Dave turned around to Jim and said

“You want to speak to them Jim?”

As I slid the side door to the van open, they all turned around and the look on their faces was priceless. They obviously either didn’t know about Daves little project, or didn’t realise there was an Regimental Police officer in the van, but as Jim stepped out and walked over to them, they all jumped to attention in a second.

“Shit Sir! Sorry Sir!!,,,,Really Sorry Sir. We arent doing anything Sir….honest!”

“Ok Boys, time to go home now. Understood?”

“Yes Sir, Sorry Sir……Really Sorry Sir. Thank you Sir”

I was gob smacked. Can you imagine if the youth and the less than responsible members of our communities had that sort of respect for our police officers?

It was over almost as quickly as it started, and just in time, as another job came through for me. This time though, it came from Ambulance Control.

“Police Medic from Red Base…Are you available to attend a Category A collapse in Outer Town Street (see what I did there?)”

Dave overheard the radio message and said that it wasn’t too far away and we would be able to attend.

Blue lights on and off we went. On scene in 4 minutes to looks of bewilderment from a crowd of young adults on their way home. I get out and recognition (but also puzzlement) comes across their faces as I introduce myself to the patient who is lying down on the side of the road.

A quick bit of history from the bystanders reveal that this young lady (about 25yr old) wasn’t actually with them, but they had been walking home and had come across her. She was half on the path with her feet over hanging the curb. Initially unresponsive to pain, smelling strongly of alcohol, and lying face down. I am immediately concerned that there is a possibility that this is more than just a drunk and incapable call. Maybe she has been hit by a car, maybe she has been assaulted, maybe she has been sexually attacked?

Without any history from her, I decided to plan for the worst and work backwards from there. With the assistance from the chaps in the team, we log rolled her whilst maintaing her C-Spine so I could check the front of her. This showed some bleeding around the face and a wound to her chin and cheek. She was well dressed and had a large tight coat on which I undid and had a quick glance over for any obvious injury (I wasn’t willing to expose her in the street without warmth and a private space to do so). She was still unresponsive to painful stimuli but her pupils we reactive and she had a strong radial pulse. I wanted a BP but couldn’t get the coat off without moving her around to much and the sleeve wouldn’t roll up far enough.

Out came the tuff cut scissors and I started to cut up the sleeve of her coat. Miraculously, this appeared to stimulate her far better than the pain I was suppling to the angle of her jaw the minute before.

“What the F*&k are you doing!!”

As she shouted at me she lunged up off the floor with such a speed that I lost my footing and staggered backwards. Before I even had the chance to regain my balance, I had 3 police officers and I Military Police Officer around her. This is fantastic!!!

In between cursing and telling me she was going to sue me for the coat, I managed to find out that she had actually just been walking home and had fallen/tripped against a broken pavement stone on the pavement. She denied being unconscious at any time, however my assessment suggested otherwise, even though it appeared she may well have just been very good at tolerating pain. All in all, there were too many warning flags for her not to go to hospital.

Instead of calling for an ambulance, we explained that we would take her up in the police van so that she could get seen and have her face sorted out. She settled down en route, but either way, even if she ‘kicked off’ again, I don’t think I have ever felt safer in my performing my duties than when I am working with the team!

This is just the beginning of the trial. We are all hoping for more funding and a continuation for the next year so that this can be fully evaluated and the benefits for all services can be laid out in black and white. We do have one wish though, a purpose built vehicle with both a cage for the naughty people and a sitting area/treatment area for the injured or ill would be great.

Fingers crossed.

Posted by: medicblog999 | October 20, 2010

A Scoop for the Medic Cast

Ive just been out walking my dog and using the opportunity to catch up with my plethora of podcasts that I like to listen to.

This morning was the turn of Jamie Davis’ Medic Cast.

The latest episode has Jamie  and Tom Bouthillet, the ECG and Cardiac Guru himself, and author of Prehospital 12 Lead blog interviewing Dr. Monica Kleinman, incoming Chair of the Emergency Cardiovascular Care committee at the American Heart Association (Heart.org/cpr) about the 2010 AHA Resus Guidelines.

These were published on the same day as our European Guidelines and they pretty much match up. Tom and Jamie ask some great questions including, why the AHA decided not to implement Cardio Cerebral Resuscitiation (i.e. taking the ventilations out as an intial priority).

It just goes to show what the social EMS scene has to offer. How many other shows have you seen or heard on any media format which have been able to discuss this with one of the authors of the guidelines within 12 hours of the publication of the document!

Great Job Jamie.

Go to the Medic Cast website to listen to or download this fantastic interview. It really is a must.

Posted by: medicblog999 | October 18, 2010

Working a Police Paramedic Shift – Part 1

As you know, I have been spending time with a local police force in a unique and novel project for working together to combat drug, alcohol and violence in a local town centre. For an explanation about how it works you can click here for an earlier post, but tonight I thought I would take you through one of the shifts I have worked. Obviously various facts have been changed to protect patient and offender anonymity.

I Start work with the team at 1800, after I have stopped off at a local ambulance station to pick up the various medications that I need to have available for the upcoming 8 hours working with the police. Once I arrive at the police station we all deal with the most important part of the night…..Kebabs, Pizza and Chips!

Once we are fed and watered I head down to the police van to check the equipment that I carry :

AED with basic four led monitoring equipment

Full Paramedic Kit,

First Response Bag,

Oxygen,

Entonox,

Full Selection of Paramedic Drugs.

Once thats all done, its time to head out on patrol.

It has to be remembered that this is primarily a police resource with a core function for the prevention of violence and alcohol crime within the town centre. They run a zero tolerance approach to drunken behaviour and underage drinking and for the majority of the time on shift, that comes first.

The sergeant, Dave, calls in to the police control to let them know that they have a paramedic on board and he asks them to consider us before calling for an ambulance if any thing happens in the city centre (Unless it is a serious and life threatening incident of course). I also call into my control and let them know that I am on shift and can be contacted if they would like to request us to respond on behalf of the Ambulance Service in and around the town centre. The important word there is request. If the ambulance service want us to travel outside of the town centre boundary, it has to be okayed by Dave. If the town is busy or they are in the middle of police duties, then they can, and do knock back ambulance jobs. This is rare however, and in the most part, if an ambulance job comes in as a Cat A, then we will go.

As we drive around, there are 5 sets of eyes looking out of the police van looking for signs of people being a little bit naughty. Its not long before we come across a large collection of teenagers sitting in a park area within the central area of the town. One of the officers expertly spots a bottle of cheap wine being hid behind a coat, and thats all that is needed for the van to come to a halt and the team to decamp. In these circumstances I tend to stay with the van. I will get out, because im nosey like that, but I don’t get involved in any policing matters. That would just muddy the waters just a little too much and would risk me as a medic losing my neutrality as part of the team.

I have to be honest, the first few shifts, I found it a little uncomfortable being part of these incidents. Dave and his team take no cheek or attitude from these ‘colourful characters’. If they are respectful to the police then they will be spoken to in an adult manner and with respect. If however, they decide to try it on, then the zero tolerance side of the team comes into play and they are left with little doubt about who is in charge and what is expected of them. This is obviously all done verbally, and now I have been part of the team for a number of weeks, I understand and appreciate the dynamics of this difficult relationship between police and those involved in petty crime and disorderly behaviour.

As they were dealing with the underage drinkers, another side benefit comes into play with me being on scene. I have a fluorescent yellow and green jacket on that shouts out that I am a paramedic. This tends to draw a little bit of attention, but usually just those who are interested in why I am in a police van. Once it is explained what I am doing there, and that it means if anyone gets ill or hurt in the town centre, they will have a paramedic by their side in less than two minutes, the response has been universally positive and creates a good talking point for a little while.

Whilst this discussion was going on, alcohol has been tipped out and the teenagers have been told to leave the town centre. As they walk off, shoulders hunched and attitude well wound in, we get back into the van and head off for another tour of the area. A couple of minutes later Dave’s head twitches to the side where his radio is attached to his coat as he listens in to some radio traffic. A man has been assaulted at a bar around the corner and the police officer on scene is asking for an ambulance.

“Yeah, hang off on calling for the ambulance, we have a paramedic on board and will go and check it out”

Less than a minute later, a police van turns up outside of a bar, the side door slides open, and out jumps a paramedic!

After a few quizzical looks, I get on with doing my usual job and assess the patient. He has a small cut to his forehead where someone punched him whilst wearing a ring. It is a minor wound but will need either stiching or gluing. There was no loss of consciousness, he has no other apparent injury and his observations are fine. Its still early in the night and he has only had a couple of drinks and doesn’t appear intoxicated.

I advise him that he needs to be assessed at the local hospital so that the wound can be closed. After dressing his forehead, he promptly jumps into a waiting taxi and heads off to the hospital less than 10 minutes away. I complete my paper work, Dave competes his log and we are off again.

From time of call to patient leaving scene – 8 minutes!

We stop off at numerous bars to chat to door staff and managers. Dave and the team share a good banter with them all and get some information about who’s in the town and whats going on. All of the bars, clubs and late night shops all have a dedicated radio service so that if anything happens they can link straight up to Dave’s team without calling 999. This again makes for an incredibly fast response time and fosters a real air of community between the publicans, shop owners and the police.

As we are sitting outside one of the shops, Dave hears one of the door staff calling for police assistance. He has been assaulted and has a head injury.

Again we are on scene in less than two minutes. This time the wound is a bit worse and is still freely bleeding. A dressing, some direct pressure and a quick assessment later and he is sitting next to me in the back of the police van whilst we drive him the short 5 minute journey to the local hospital. Again, no need for an ambulance, just transport to the hospital. In this case, and many others, the team are happy to use the police van instead of calling an ambulance into the town centre. It is a real benefit having the hospital so close to the centre of the town!

Even though we transported this patient to the hospital, we were again back in the town centre and patrolling in under 20 minutes from the time of the call.

It wasn’t long however, until the fifth member of our team, a British Army Regimental Police Officer,  had to be called into action – but that is for the next post!!

Posted by: medicblog999 | October 17, 2010

The Clash of the Assessments!

This post may come out a little rambling, but that is only because I am trying to structure a balanced discussion inside of my head instead of an all out ranting post!

In the UK over the last few years, we have seen hundreds of NHS Walk in Centres (WIC) sprout up around the country. These are primarily Nurse led units that are placed strategically in various towns and cities to provide care for those residents who are suffering from either minor injury or illness. They most definitely have a place in the wider primary health care environment, but ask any Medic what they think of them, and most will tell stories of picking up patients from the Walk In Centre to take up to the Accident and Emergency department who clearly do not have any specific life threatening or emergent need, and who, in the paramedics opinion should have been treat and discharged from the Walk in Centre.

There is the other side of the argument as well though.

My service has direct referral pathways to the Walk in Centres. If I have a patient who I think fits the fairly strict criteria for assessment and treatment at a WIC, then I can contact one of the nurse partitioners on the phone and discuss my patient so that they know what I am bringing in and more importantly that they know they are suitable for their level of care and will not need to be shipped out to the A&E department at a later time.

Fair enough right?

This system SHOULD work, but there are a number of crucial factors that keep rearing their heads which result in a certain level of disillusionment from the Ambulance crews and frustration from the WIC nurses.

Now, instead of just going off on one about how you have to virtually fight tooth and nail to get a minor injury or illness patient through the door of a WIC, I will try to look at it from both sides.

There are good paramedics, there are average paramedics and there are bad paramedics (hopefully working down in frequency too!)

There are good nurses, there are average nurses and there are bad nurses also (again hopefully more of the good than the others!)

The reason why our referral pathways keep on coming up short to this particular care provider is that a small minority of practitioners on both sides, cause trouble which affects the way the whole service is perceived.

I have numerous stories of nurses refusing to see patients which I know are completely suitable for assessment in a walk in centre.

I have numerous stories of patients we have transferred to A&E from a WIC who are quickly assessed and discharged home within a very short time of arriving in the department.

I am positive that the nurses have numerous stories of the paramedics who brought them patients who very quickly needed transporting up to A&E because they were far more unwell than what was made out in the handover. I am sure that there are also many stories of patients who have arrived by ambulance who have not had a thorough and full clinical assessment before the medic has decided that there is nothing much wrong with them and they can go to the WIC.

All it takes is a run of these before the paramedics decide that its not worth even trying to take someone to a WIC, or the nurses become so suspicious of incomplete assessments or a lack of trust in the paramedics, that they knock patients back who are more than suitable for there level of care.

There needs to be a rebuilding of trust between the two professions, and it needs to start sooner rather than later.

If I contact a nurse at a Walk in Centre to discuss the care of a patient, then I have already completed a full and thorough assessment, have made my provisional diagnosis and have decided on the most appropriate course of action. I will provide a professional and full telephone handover and answer all of the questions that are asked of me and about my patient. I am a professional care provider in the pre-hospital environment and I would give anything for the minority of these nurses to trust in my judgement. The majority of these do know me and know that when I ring, my patient will be suitable; but sometimes, even I get to the point when I think that there is no point in even trying any more.

Paramedics also need to realise the limitations that these nurse practitioners have too. They work to guidelines just like us, and even though we may think it is appropriate, the patient presentation may fall outside of their scope of practice (even if it is a minor problem). If that happens, then do we really expect them to just do their own thing and go against their guidelines? Would we?

There is a reason why A&E is the default option when no other referral pathways can be made available. They don’t close, they don’t say no, and the always see whatever comes through the door.

That doesn’t make it right that they should be the dumping ground for the minor injury and minor illness patients.

There is a lack of understanding and a lack of respect from both sides. If we get this right, we could have a valuable resource to the community. Its just going to take some time and some real effort.

Im willing to put the effort in. I hope everyone else is too……

Posted by: medicblog999 | October 17, 2010

Ambulance Matters Podcast – Episode 1, Now Live

Its taken a little bit of fiddling around with the new blog site, but Episode 1 of the new UK Based EMS/Pre-Hospital care podcast is now live and available to listen to online or download to whatever generic music player you have!

In this first podcast, my panel of operational medics and I discuss a blog article from Insomniac Medic that referenced a recent news paper article which held the headline of “UK Paramedics sent to emergency calls without ambulances”.

This was referring to a new trial by London Ambulance Service which is currently underway in one part of their service area. After putting the facts in place to dispell the sensationalised headlines, we carry on with a great discussion on the future of EMS in the UK.

Visit the Ambulance Matters website to listen to or download the podcast, and please let me know what you think in the comments section on the podcast web site.

Remember, Im very new to this hosting lark, and I can take constructive criticism well!!

Posted by: medicblog999 | October 15, 2010

Been a little busy podcasting!

Just wanted to drop a quick note to apologise formy absence from the blog this week.

As you all know, I decided to finally jump into podcasting and this week, thanks to the purchase of a MacBook (Thank you Mrs999) its all fallen into place.

Last night I recorded the first two episodes of The Ambulance Matters Podcast. They were both very well attended by guests from far and wide and the discussion was fantastic.

Im really excited to share them with you but im currently trying to fathom out how to get the podcast onto iTunes.

I dont want to publish the podcasts just on ambulancematters.com without having the option to download from the iTunes store, so youll have to wait just a little longer!

Normal Blogging will resume in the next few days.

Posted by: medicblog999 | October 11, 2010

A Police Ambulance?????

 

If you have been following me on twitter (@UKMedic999), you will know that I have been participating in a fairly unique project going on in one area of my service. As I have been getting more experience in this role, I have wanted more and more to share what has been going on and find out if you have anything like this where you work. 

So what it is it? 

In my service, when I work on a response car, I am not allowed to be knowingly sent to a patient who is under the influence of alcohol or recreational drugs or has been involved in a violent incident. At times, this must be extremely frustrating for those in the control room, to have a paramedic sitting in a car when jobs are coming in left right and centre which are not suitable to send that resource to. 

There is currently an initiative in another area of my service which is trying to deal with this very thing. In this trial the paramedic has a police officer with him, so that he can be ‘protected’ if in a higher than normal risk environment. This car is under control of our own call centre and whilst it is primarily designed to deal with the main city centre area, it can very easily be pulled out to more remote areas if that is the only resource left. 

Another option is the scheme I am involved in. I believe it is unique, and I am 100% bought in to the value of its presence and the effect it is having in a multitude of different ways. 

In this post, I will explain how it works, then I will follow up in further posts to give examples of the project in action and the benefits to truly working in partnership with our colleagues in the police force. 

Each Friday and Saturday night when I am not on my rostered duty shifts, I travel down to a town called Darlington. Darlington has previously had a bit of a reputation for the myriad of problems that come along with being a busy town centre with alot of bars and nightclubs and young people. Add to that, the fact that 15 miles away is Europe’s largest Infantry training base, and you have a recipe for a particular type of problem with a particular type of response. 

The brain child of Sergeant Dave Kirton, from Durham Constabulary, the Darlington Police project is truly unique in its approach to caring for the people moving into the town centre for hopefully, a night of fun and frivolity on a Friday and Saturday Night. 

Dave runs a local team of Police officers who drive around the town centre enforcing the strict local laws on underage drinking, disorderly conduct and ensuring the smooth running of the “night time economy” within the town (as far as possible). 

Dave noticed a hole in the provision within the town centre. 

Namely the amount of time that the local police officers had to wait for an ambulance response for the more minor and frequent calls for medical assessment from his police officers on the streets – assaults, drunken people incapable of looking after themselves and the more minor medical complaints that seem to raise their heads in the presence of copious amounts of alcohol. There was also the issue of the amount of soldiers coming into town when on R&R from their training camp. 

The solution seemed easy enough. There were 6 seats in his police van and currently only 3 Police officers occupying them. 

After a prolonged negotiation time with the Ambulance Service it was agreed that a paramedic would be provided to work alongside the officers on this team and provide immediate triage to the `potential patients` that his colleagues were calling ambulances for. 

The other string to the bow of this new town centre resource was the presence of a Military Police officer from the local Garrison to help control any of the more ‘lively’ elements of the infantry recruits that were travelling in for some well deserved down time. 

The team was now complete. 

1 Sergeant 

2 Police Officers 

1 Paramedic (Cat C Trained so they can diagnose and advise on scene) 

1 Regimental Police Officer. 

This works very, very well, but only due to a couple of reasons. 

  1. The vehicle and our responses are controlled by the Police officer in charge of the vehicle (which is usually the Sergeant)
  2. Dave actively listens to his radio channel for any officers calling out for an ambulance. Once he hears a request, he will relay that to me and ask if we can deal with it. We will always attend anyway, but if it sounds like a minor illness/injury that we can deal with, we will get the ambulance travelling in, to stand down.
  3. The Ambulance service does not get to allocate the details. If a job comes in to my radio from my control and it is not “life threatening”, I will ask Dave if it is appropriate to help. Usually, if it is close by, and the town isn’t too busy, then we will attend and care for the patient. If however, Dave believes that moving out of the town centre is not an option (for whatever reason) then we will not attend. After all, it must be remembered that this is primarily a police resource.
  4. Once on scene with a patient, the dynamic of the team changes and I then take the lead with the police officers helping out as directed.
  5. Once my assessment is done, if the patient needs to go to hospital, if Dave agrees, then we will transport the patient to the local A&E department (which is only a 5 minute drive from the town centre) in the police van (No, not in the cage!) so that we can keep an ambulance free to attend other more serious incidents in the wider area.

The benefits to this system are numerous. 

  • The response times to jobs in the town centre are usually less than 1-2 minutes.
  • Once on scene, the other officers dealing with the patient can be made available for other duties whilst we, as a team, take over the care role.
  • The community sees a cohesive partnership working together to keep their local area safe.
  • We are responding to calls which would have resulted in an ambulance response to the city centre.
  • The police members of the team are also trained in MOE (mechanism of entry) techniques, so if they are called in to force entry into a location for a ‘concern for occupant’ call, then I am there with them to provide care to the patient once we gain entry to the property.
  • If any of the police team either in the van or in the town centre gets injured, again, I am right there!
  • There are financial incentives (especially for the ambulance service) involved in hitting targets and reducing the amount of ambulances having to come into the city and transport patients to the hospital.
  • The police do also have their primary role to perform and at the times when they are dealing with the less compliant members of the community, I tend to just stay next to the vehicle and keep a low profile. I do not get involved in any violent scenarios until my colleagues have made the area safe for me to work in. 

    My Alternate treatment area (the back step!)

     

    Our police van does have a cage in the back, and is used for arresting people and transporting them to the cells if required. Again, in these circumstances, I just keep my head down and try to keep out of the way. Surprisingly though, we have also found that the presence of a paramedic on a scene which was initially violent can be a bit of a calming effect for some reason! 

    Over all, I am honoured and very excited to be part of this project. I can see the benefit of this rolling out to many areas across the United Kingdom, and with a little bit more tweaking and a custom vehicle which can have a little patient treatment areas as well as the cage in the back; we could really be onto something special! 

    I’m sure you have lots of questions. 

    Ask away and I will try to answer them as best as possible and even pass them onto Sergeant Kirton if needed. In fact, that’s a good idea………Let’s see if I can get him to write a guest post. 

    More to come…. 

Posted by: medicblog999 | October 10, 2010

Smile or Cry??

This has nothing to do with EMS, but has everything to do with human emotion.

As I was flicking through my google reader account, I stumbled across this embedded video on Medic Birdie`s blog.

Im not ashamed to say that I blubbed for the next 10 minutes as I watched it.

I still dont know if it ultimately made me feel happy or sad, but I do know that it is powerful stuff, and therefore I wanted to share it with all of you.

[pro-player width=’530′ height=’253′ type=’video’ image=’http://www.youtube.com/watch?v=uSMlIM9zLio&feature=player_embedded’%5Dhttp://www.youtube.com/watch?v=uSMlIM9zLio&feature=player_embedded%5B/pro-player%5D

Posted by: medicblog999 | October 8, 2010

Social Media to the rescue, Again!

I have written in the past about how social media had a direct impact on a patient care episode that I was involved in.

That reinforced the strong belief that I have, that what we do in the EMS Blogosphere can transcend the obvious benefits of creating more dynamic thinkers, and increasing provider’s professional knowledge about various aspects of what we do. It can actually directly benefit patient care.

This has been proven again, in a very real way over the past couple of months.

I was contacted via email from a clinical radiographer who lives and works in the United States. She was looking after a female patient who was undergoing treatment for fairly advanced Cervical Cancer. The patient was a British national who wished to come back home to complete her treatment and to spend time with her family over here, just in case the treatment didn’t go as planned.

The main problem that became evident was that the patient had been told from her oncologist that it would not be in her interests to travel back home because the waiting times for treatment in the UK would be so long that it would likely be of detriment to her and her eventual prognosis.

The radiographer (lets call her Julie) who reads my blog, sent me an initial email to enquire if this was true or not and asked my opinion if her patient should indeed stay in the U.S to finish her treatment before returning home.

Fortunately, due to previous nursing experience, and personal family experience, I know quite a bit about cancer services in the UK and I didn’t think that this would be an issue as long as the appropriate referrals were put in place before she left the USA and the journey took place at a time where the break in treatment would either be nil, or minimised as much as possible. But I had to do some research first.

I contacted our regional Cancer Care Centre and discussed the case with a specialist in Gynaecological Cancers, who confirmed that the delay would be minimal, but there had to be certain things put in place first, including a referral from the patients GP. Once that was all done, then it would be fairly straight forward for her to continue with her treatment after case notes etc had been shared.

I passed all of this information back to Julie, who emailed back again a couple of days later to tell me that the patients doctor had agreed to the move back to the UK and the patient (and her family) were in the process of contacting the patients old GP in the UK, who amazingly was in my own working area!

Everything went quiet for a few weeks, and then I received a final message from Julie stating that her patient was preparing to leave and return to the UK, where her treatment would continue under the care of oncologists in the NHS in my local hospital.

It really is a small word isn’t it? Amazingly, more and more we all seem to have a part to play in other peoples lives (no matter how far away they are, geographically)

Remind me again, how social media is a bad thing???

Posted by: medicblog999 | October 5, 2010

My first audio post.

Well, Ive only gone and done it!

Ive been threatening to go and start a podcast for a while, and now there is no going back.

The Ambulance Matters Podcast now has its own site (www.ambulancematters.com) and whilst it is but a mere shell at the moment, it is there and it is live.

Im starting to look at how to physically do the podcast thing, but in the meantime, you can hear me talk about what I hope this podcast is going to be about over at the site now.

Heres the link, go take a listen then be brutally honest with me when you get back!

Posted by: medicblog999 | October 4, 2010

The start of something new!

So I have finally decided to go ahead and give this whole podcasting thing a bash! I have finally found the right software to use and have started doing some trial recordings.

This podcast is hopefully going to come with something a little unique. Many of you who follow either myself, or my good lady wife (@Mrs999) on twitter seem to enjoy some of the ‘good natured’ back and forth that we have when communicating through tweets.

As you know, she is also a paramedic (and most likely a better one than I) and although she keeps saying that she is shy, we all know that not to be true, right??

So I have this crazy idea that she hasn’t exactly agreed to yet….Well, she doesn’t actually know about it, but hey, why should that stop something special? How about a UK based EMS Podcast to showcase what is good, bad, different, interesting, new, challenging and exciting in the world of Pre-Hospital care in this little ‘ol island of ours. However, in our show it will be hosted by both Sandra and I. A real husband and wife team!

This may end in tears. After all, when we have our dinner table discussions, one of us always seems to play devil’s advocate just to antagonise the other (or rather I do!)

I’m hoping for this to be a general discussion podcast, with issues coming from the news, the blogosphere and operational staff. It will be as informal as possible and open for all to come on and have a chat.

There is one BIG warning though. I am no Chris Montera (EMS Garage), Jamie Davis (MedicCast), Kyle David Bates (First Few Moments), Justin Schorr (The Happy Hour), Greg Friese (Medical Author Chat) or Ron Davis & Kelly Grayson (Confessions of an EMS Newbie). I am just me. I know I won’t be the most dynamic or exciting host, but that is where our Guests and my wife will come in. She can be the Glamour!

I’m excited to get this all started, but for now, I will be running some practice Skype calls and quickly learning how to edit and produce a podcast. I am not going to commit to a time frame and at this time I cannot even commit to a frequency of the podcast (I need to see how much time the University course takes up first), but I am hoping for bi-weekly to start with.

Watch this space for updates and if anyone wants to get involved in designing some images for the podcast or putting a theme tune together, then you know where I am and I would be really grateful for any help from those of you out there far more talented than I.

And what about the name……….

“Ambulance Matters”

Thanks to Insomniac Medic who inspired the shortened title from his original suggestion. The title, I hope, brings two separate meanings. Firstly, a collection of stories and discussions about what is important in the ambulance service, what really matters; then also just the fact that ambulances and those who work on them do actually matter!

Posted by: medicblog999 | October 2, 2010

The EMS Blogosphere goes pink!

If you didnt already know, this month is Breast Cancer Awareness month.

Two fellow bloggers, EpiJunky and The Happy Medic have started a bit of a campaign going to raise awareness and promote a bit of a co-ordinated response for all of us who blog.

Im a few days behind unfortunately, but its never to late to do something to raise the profile of anything to battle the fight against cancer.

Epi and Happy are asking for everyone to go and have a look at the EMS For a Cure campaign and donate if you feel that it is something that you should be helping with. I dont know many people who havent been touched by breast cancer within there family, I know how hard it was for my family to travel along the treatment journey with my mother in law, watching her really go through some tough times, but fortunately coming out the other side with a good result.

More details can be found over at Happys Blog, including a passionate video from Justin.

For those of my readers from the UK who would rather donate to a cause in this country, then here is a great place to start.

For my fellow bloggers, why dont you go pink for the next two weeks too?

Backgrounds and widgets can be found here

Posted by: medicblog999 | September 28, 2010

Day One of University – Shock and Awe!

So, this is a double blinded trial then??

Today was the first day of a three year road to a Masters in Clinical Research.

I didn’t have any expectations for the day. I didn’t know who would be on the course (apart from the other 2 paramedics from my service who were successful in their scholarship applications too), and I didn’t know what the level of the subject matter was going to be.

I know now!

As far as who are my fellow students……They are a really good mix of medical professionals. I think that all of them apart from us three paramedics have some working knowledge of clinical research. A large chunk of them are doctors or Research nurse specialists already working in the field and participating in various clinical trials.

As for the level of the subject matter; this first year leads to the initial qualification of a Post Graduate Certificate in Clinical Research. The fact that it is post graduate appears to me to assume that a certain working knowledge was to be expected from most in the room. Our module leader seemed a little surprised when during the evaluation at the end of the day she asked if it was ‘new knowledge’ to any of us, and the three of us all said ‘Yes’.

The most important thing for me though, was that I kept up; asked alot of relevant questions to try and clarify things in my head so that I can move past the feeling of bewilderment towards a general low level understanding of some of the more important legal and procedural issues that I will have to address as I move through my studies and on towards a possible career in a research setting.

I was excited to be there, looking forward to that feeling where my brain starts to work overtime and I start to get that buzz I like when I know I am learning something that I am interested in. The academic staff seem to be really friendly and supportive and I really feel that even though this is going to be very challenging, its something that I should be able to get through.

We were fortunate to be taught all about the International ‘Good Clinical Practice Guidelines’ by a national expert; someone who managed somehow to make this three hour block very interesting. I love listening to people who really, really know their subject, to the level that they don’t even have to look at the PowerPoint slides but instead just discuss the facts and the relevant issues that we need to start to appreciate. It was a great morning followed by another couple of interesting lectures in the afternoon.

The only trouble I had was by the middle of the afternoon I was starting to realise that this really is going to be some serious hard work. By the end of the afternoon, I actually had that feeling where my head actually felt full. I was at saturation point for the day and just as we finished, I knew that nothing more could fit in there today!

We have our first assignment. They are easing us in by asking us to provide a CV which has been completed using an online tool essential to gain permissions for research from various regulatory bodies. Then, just as we were about to leave, we were all hit with a bomb shell.

“This first assignment is easy, it won’t take you long. But, be prepared for the next two. We expect that each one will take approximately 40/50 hours of work to complete to the required standard”

That’s a projected 80-100 hours of work before the hand in date at the end of November!!!

Oh Crap!

What made us feel a little better though was some of the Doctors saying exactly the same as us on the way out of class:

“Bloody Hell, that was so far above my head it’s just not funny!!!”

« Newer Posts - Older Posts »

Categories