Ask a Paramedic anything at all...
Discussion
smiffy180 said:
My partner reckons if I were to be in a position where I needed medical attention but was unable to move from the 3rd floor (where our bedroom is), the attending paramedics would be unable to take me out for the house due to my weight (25st) because of health and safety stopping them from doing so?
Is this true?
It would present a challenge, obviously - but there's no 'health and safety' limit as such - we're just trained to do a dynamic risk assessment. As I have said before we can call for backup for anything like this, from our own 'HART' team to the fire brigade. We'd get you out, don't worry about that.Is this true?
numtumfutunch said:
Thanks for the thread
Having recently been caught in the position where I was sitting at a red light with an ambulance coming up behind with lights and sirens on how many and what percentage of your call outs are really so urgent that 30 seconds would make a real difference?
Cheers
In the spirit of answering questions honestly.....on an average day, I'll concede that the percentage may not be 100% - but I will fall short of estimating a figure because I don't want to bring any disrepute! I guess I will just say, every day is different...Having recently been caught in the position where I was sitting at a red light with an ambulance coming up behind with lights and sirens on how many and what percentage of your call outs are really so urgent that 30 seconds would make a real difference?
Cheers
Sometimes though.....yes, 30 seconds might make all the difference. And looking back.....it has done.
ashleyman said:
Do you use ‘ambulance slang’ on the job or is it just a myth?
Stuff like purple plus etc...
I am lead to believe that this kind of thing DID go on a number of years ago - not just on ambulances but in hospitals......things like 'NFN' meaning normal for norfolk, right?! I have heard the stories, yes!Stuff like purple plus etc...
However I have to say - since I joined at least - this is a total no-no! Patients have the right to access any paperwork we write as well anyway, not to mention that it's completely unprofessional!
Fattyfat said:
Ray Luxury-Yacht said:
Inspired by other threads, of which I have enjoyed the insight, so I thought I might do the same. Ask within reason though, obviously 
and we're seriously constrained by patient confidentiality too, so some answers might be a bit vague. I won't be entertaining 'flippancy' or gore hunters, by the way 
Oh, and I work ridiculously long hours on shift work too, so the replies might take a while haha!
We're definitely having the most challenging winter I have ever seen so far too, it must be said. I'm proud of my Trust, the NHS and my colleagues, and what they've all managed to achieve in light of such adversity so far.
How long are you qualified now? I remember chatting to you just as you started training. and we're seriously constrained by patient confidentiality too, so some answers might be a bit vague. I won't be entertaining 'flippancy' or gore hunters, by the way Oh, and I work ridiculously long hours on shift work too, so the replies might take a while haha!
We're definitely having the most challenging winter I have ever seen so far too, it must be said. I'm proud of my Trust, the NHS and my colleagues, and what they've all managed to achieve in light of such adversity so far.
thanks for posting! I qualified in August 2015, so it's been getting on for two and a half years. Still (mostly) enjoying it, but I have to say, this winter has tested me somewhat! Willy Nilly said:
Do people ever thank you?
Yes, all the time. As I said in an earlier post, one of the things that often helps us get through some difficult days, is the way that we're regarded so highly by most of the general public. I get genuine thanks from patients and their families on a day-to-day basis, which is lovely. Better still, many of them take the time to write to my Trust with a formal thank-you, and I'm pleased to say that the Trust forwards on a copy of every letter and email like this, with a covering thank-you letter from senior management.
Then I often get just random people coming up to me in public and saying something like 'oh you guys were brilliant when I / my family needed you, thank you for everything that you do.' In fact I popped into a kebab shop on my way home from a shift the other day, and a man came in and stood next to me. He began telling me how much he was grateful for us, and shook my hand. After a while, I told him I should get out of his way as he wants to order a kebab, to which he replied 'oh I didn't come in to get a kebab, I just saw you when I was walking past outside and wanted to thank you...'
Brings a tear to the eye sometimes.
jet_noise said:
Do you have a protocol for an Addisons Disease patient in crisis?
No cheating, put the portable 'phone away!
Yes I have that rare condition
We do, although I have never come across a patient with it yet. We carry Hydrocortisone, and fluids if needed too. I understand that it can however flare-up to be pretty nasty, and even life threatening. So following that treatment it would then just be a case of pre-alerting the hospital and blue-lighting you in.No cheating, put the portable 'phone away!
Yes I have that rare condition
One thing I might note regarding some of these rarer conditions that ambulance staff rarely come across, is that I usually find that the patient is very well-versed and knowledgeable about their condition. In these cases I am happy to be guided by the patient and treat accordingly, within reason. So if the patient tells me that this / that helps them specifically, then I'll go with that.
Crossflow Kid said:
Thing is, "mental health" is such a broad term.
The full-on voices-in-their-head Jesus-told-me-to-do-it cases have always been there, and are relatively straight forward to treat in the emergency care setting...."Get in the ambulance then. We'll go and see Jesus"
What I believe is on the increase is the awareness of conditions like anxiety and depression, leading to far more cases being reported, identified and diagnosed.
I'm also a firm believer that society as a whole has made itself more fragile in recent times.
Loss of genuine social networks, higher lifestyle expectations, money, peer pressure, overpopulation, poor housing, crap diet, questionable parenting and more are making life a real challenge for far more people.
That's not to say individuals are more fragile, and nor are their cases any less genuine, but I feel the public focus on recent large scale events, and I'm talking right back to the decade that Health and Safety forgot....the 1980s, lead to a culture where saying "No really, I'm ok" is seen as a weakness/denial where admitting to a mental health issue used to be.
Add to that the compensation culture and, sadly, genuine mental health cases are getting lost in a sea of complete nonsense from people who can see an easy, ambiguous option to get time off work and/or more money.
Post-Grenfell I went to lady who was attempting to claim the full assistance package. She wasn't in the Tower, never had been, didn't know anyone who was.
On the night of the fire her cat got scared by all the fire engines and ran off. No one in authority wants the job of telling her to get a life as that's seen as hurtful, old fashioned and callous. In contrast, my only other post-GT case was a man who collapsed in the street having visited the site for the first time (four months) after the fire which claimed six friends or family (Inc two pre-school children)) and who were, at that time, unaccounted for but presumed to still be in the building.
Both mental health. Both entitled to treatment.
I'd agree with this 100%, well said. I might add, however ( and I'm not getting political, just stating facts as I see them) that there have been rafts of cuts to local mental health and social support services in the community over the last few years. Hence, especially out of normal hours, I am dispatched to a mental health crisis which might well have easily been attended to by more relevant services previously, but has escalated to the extent that an emergency ambulance is the only resource available.The full-on voices-in-their-head Jesus-told-me-to-do-it cases have always been there, and are relatively straight forward to treat in the emergency care setting...."Get in the ambulance then. We'll go and see Jesus"
What I believe is on the increase is the awareness of conditions like anxiety and depression, leading to far more cases being reported, identified and diagnosed.
I'm also a firm believer that society as a whole has made itself more fragile in recent times.
Loss of genuine social networks, higher lifestyle expectations, money, peer pressure, overpopulation, poor housing, crap diet, questionable parenting and more are making life a real challenge for far more people.
That's not to say individuals are more fragile, and nor are their cases any less genuine, but I feel the public focus on recent large scale events, and I'm talking right back to the decade that Health and Safety forgot....the 1980s, lead to a culture where saying "No really, I'm ok" is seen as a weakness/denial where admitting to a mental health issue used to be.
Add to that the compensation culture and, sadly, genuine mental health cases are getting lost in a sea of complete nonsense from people who can see an easy, ambiguous option to get time off work and/or more money.
Post-Grenfell I went to lady who was attempting to claim the full assistance package. She wasn't in the Tower, never had been, didn't know anyone who was.
On the night of the fire her cat got scared by all the fire engines and ran off. No one in authority wants the job of telling her to get a life as that's seen as hurtful, old fashioned and callous. In contrast, my only other post-GT case was a man who collapsed in the street having visited the site for the first time (four months) after the fire which claimed six friends or family (Inc two pre-school children)) and who were, at that time, unaccounted for but presumed to still be in the building.
Both mental health. Both entitled to treatment.
This is frustrating in many ways - chiefly because when I did my Paramedic training and degree, we had next to no training in supporting mental health patients - most of the focus was, understandably, on medical and trauma management. Secondly (and I don't mean this in a churlish manner) I am not personally THAT interested in dealing with mental health cases. By that I mean, of course I do everything I can when I am dispatched to such a case, but if I had wanted to be a mental health specialist, then I would have trained to do as such!
Lastly, as said, all we can do as an ambulance crew is use our communication skills and common sense, to have a discussion with the patient about what they want to do. If they are receptive to wanting to see a mental health specialist, then all we can do is transport them to A&E for an assessment. Which is not ideal because if it is out of hours then there is a good chance that they will just sit in A&E, taking up a bed space, sometimes until the next morning. I'll also add that many mental health patients have been drinking before our arrival, but the team in A&E won't even consider giving them an assessment until they're sober. So it might be 12 hours or more until they finally get proper help. Which is entirely inappropriate, as I am sure you'd agree.
Crossflow Kid said:
Ray Luxury-Yacht said:
Then I often get just random people coming up to me in public and saying something like 'oh you guys were brilliant when I / my family needed you, thank you for everything that you do.'.
Indeed.Go in to Costa etc in London, order a coffee and quite often it comes back on the house.
Pret-a-Manger are the gold standard though.
My crewmate and I have in the past been given an entire breakfast plus extra to see us though lunch.
During the London Bridge incident last year, McDonalds provided free food and drinks all night long.
I'm not in the city like you, so I don't have a Pret nearby, and only one or two Maccers within my patch. That said, we have a small local Tesco and Co-Op in our ambo station's town, and the both send us a load of nice food and things every Christmas. Gratefully received!
tighnamara said:
What’s your view on single manning of ambulances, seemingly in the last year it has been quite high due to holidays and illness.
Presuming that if they can’t get someone to cover, the ambulance would be taken off the road for the shift.
Are calls vetted more when only one person attending or does police have to be in attendance ?
Sounds quite exposed for one person attending a scene unaware what to expect.
We've been using single-manned ambulances for years - they're called cars haha! But in all seriousness, there are one or two occasions where we might have to man an actual ambulance single-manned, and it's no problem at all for me, it's no different from being on the car really.Presuming that if they can’t get someone to cover, the ambulance would be taken off the road for the shift.
Are calls vetted more when only one person attending or does police have to be in attendance ?
Sounds quite exposed for one person attending a scene unaware what to expect.
Out Trust does not like doing it, however, and will do everything they can to avoid it. This is because if you turn up at an address and the patient DOES require transport, and I point out that I cannot transport them in the big yellow bus outside myself and I will have to radio for a backup crew, then we get met with a few blank looks and questions of 'well then why did they send you?' In the instances where I may turn up to work, and not have a crew-mate to work with, I might get sent to another station, or someone might get sent to me, so we can 'pair up.' Or I may start a shift single-manned and then 2 hours later when someone else turns up we get paired up. It's unusual to go a whole 10 or 12 hour shift single manned on a full ambulance.
With regard to vetting and police presence - no, this does not happen. That said, in October 2017, all ambulance trusts nationally started to respond to a new system of telephone triage, with less focus on arrival times and targets, and more focus on dispatching the most appropriate resource for the patient's needs. I see this as a very good thing, and a really positive progressive step forwards in terms of organisational change. Proposals of this scale normally move at the pace of geology in the service - we don't like change! So it's good to see. Took a lot of planning and implementation, but seems to be working well.
As for being exposed attending a scene unaware what to expect - I think I covered that in a previous post, but essentially it doesn't faze us. Once you've done this job for a while, you've pretty much seen anything and I can't remember the last time I was surprised or caught out when I arrived as first on scene. As I said, we can call for a myriad of backup anyway, most of which will arrive pretty quickly. We have plans and protocols in place to get on with alone, until backup arrives, which we will just automatically drop into because of our training.
Finally, I have a data screen in the vehicle which gives a reasonably good description of what I am responding to, and often as more details roll in, my dispatcher will radio me or send me a text message with updates. They're pretty good like that.
magooagain said:
https://www.facebook.com/story.php?story_fbid=9126...
I thought some of you folks might be interest in the above FB link.
It's about a job position. Not sure if it's with the pilgrim bandit charity or another outfit.
Linky no worky.I thought some of you folks might be interest in the above FB link.
It's about a job position. Not sure if it's with the pilgrim bandit charity or another outfit.
Crossflow Kid said:
tighnamara said:
What’s your view on single manning of ambulances, seemingly in the last year it has been quite high due to holidays and illness.
Presuming that if they can’t get someone to cover, the ambulance would be taken off the road for the shift.
Are calls vetted more when only one person attending or does police have to be in attendance ?
Sounds quite exposed for one person attending a scene unaware what to expect.
In London, we have lots of single crew assets.Presuming that if they can’t get someone to cover, the ambulance would be taken off the road for the shift.
Are calls vetted more when only one person attending or does police have to be in attendance ?
Sounds quite exposed for one person attending a scene unaware what to expect.
Solo-crewed cars, motorcycles, bicycles and, in some locations or for special events, foot patrols.
Bearing in mind some of the infrastructure in town, the bike's (powered or not) can get places an ambulance or even a car just can't.
The big railway stations, Westfield shopping malls, inside the terminals at Heathrow, along the towpath of Regents Canal....they're a real asset.
We don't single-crew ambulances, so if someone goes off sick either a solo-responder will get pulled off a car or another depleted call-sign will amalgamate.
As for the risk to crews, solo or otherwise, it's down to personal risk assessment/tolerance and a gut feeling. We're issued police-spec stab vests too which crews are at liberty to wear as and when they see fit. I know some solo responders wear theirs by default.
I've only ever donned mine once - after the Westminster attack when we were deployed to Green Park tube on an unrelated job but still close enough (in both time and location) for there to be a significant risk of further attacks.
If there's any suggestion of edged weapons or firearms on scene, Plod are usually already there before we are, and if not we have absolute authority to refuse entry to premises if the immediate risk or threat is deemed to great.
Only had one patient Tasered so far.
Edited by Crossflow Kid on Monday 15th January 21:04
Seriously though, I don't know how you hack working in London doing this job - I know I couldn't.magooagain said:
Paramedics Required to teach military style Medical training in Dubai.
Salary $89K USD
Full time position
5-3Year Contract
25days Hols rising to 30 Days in second year
$1200 USD Flight Allowance
Email info@vetsnextstep.com for more details
This is from the Facebook page of the respected pilgrim bandit charity that helps injured ex military people.
I just thought it maybe of some use to someone.
Thank you so much for posting this with us in mind, it's appreciated. Salary $89K USD
Full time position
5-3Year Contract
25days Hols rising to 30 Days in second year
$1200 USD Flight Allowance
Email info@vetsnextstep.com for more details
This is from the Facebook page of the respected pilgrim bandit charity that helps injured ex military people.
I just thought it maybe of some use to someone.
And yeah, I have seen things like this now and again - indeed some of the 'young gun' Paramedics I qualified with are already doing similarly exciting stuff, outside of the UK. Good luck to them, but I am far too old now to consider any excitement on this level!
And as an aside, maybe I am being a wee bit risk averse - but from what I have read about how some Brits and Europeans fall fowl of the different laws out there, I'm afraid you would not get me to work in the middle east for a million pounds! Seems like a bit of a minefield at times.
Crossflow Kid said:
Have a quick search on YouTube for "EZ-IO".
When IV access is compromised the alternative is to go for Intra-osseous access.
It involves essentially drilling in to a major bone to administer drugs via the marrow.
Did one recently as it happens. Professionally I recognise that it is a useful tool we have to administer life-saving treatment to a patient - however I can't help admitting that whilst I am drilling into someone's bones, I often think to myself 'I can't believe I am allowed to do this..!' When IV access is compromised the alternative is to go for Intra-osseous access.
It involves essentially drilling in to a major bone to administer drugs via the marrow.
Edited by Crossflow Kid on Thursday 18th January 22:03
What's your Trust's guidelines on GCS score for usage? Ours is 8 or below. My patient yesterday was just about 8 - ex drug-user with many co-morbidities, suffering a hypo, with a BM of 0.9. Tried to cannulate 3 or 4 times but couldn't due to hypotension and a lack of vessels from years of IV drug use.
She didn't stir when I drilled, but did moan a bit when I flushed with 10ml of saline. The flush seems to be the thing which would cause the most pain, strangely.
Got IV glucose into her, until she suddenly sat up with a start and returned to GCS 15 with a BM of 8.0 like nothing had happened on the way to hospital. She laughed when I told her what I had done, like I was joking, Until I lifted the blanket and showed her. She nearly passed out again
JPJPJP said:
Are there many incidents of cocksockets such as the one referred to in the news recently hurling abuse at you whilst you work?
https://uk.news.yahoo.com/angry-paramedic-blasts-m...
Fortunately for me, very few and far between. The London boys might say different though! https://uk.news.yahoo.com/angry-paramedic-blasts-m...
I have had a handful of occasions when someone might approach me and ask if I can move the ambulance so they can get out, and for the most part, they have been quite polite. I'm never obstructive on purpose either - I'm not on a power-trip - and if I can move the ambulance, then I will. If I can't, then I politely explain why not, and most people accept this. Funnily enough, the only few people who have tutted and huffed at me were women, which I was surprised at. One recently went off and sulked in her car, and when I moved the ambulance once I had the patient on board, she drove past and gave me the shaking of the head treatment.
I never get annoyed though, in the same way that I never get annoyed at any 'challenging driving' I come across when I am driving on blue lights. I think some emergency service staff forget that whilst we are at work, we are doing a difficult job with sometimes life-threatening incidents, and running on adrenaline. However, outside of our little bubble, the rest of the public around us are all just trying to live their lives, go to work, deal with their own problems, or whatever - and so, can't really be expected to understand the thing that WE are dealing with at that particular moment. It's unrealistic to expect otherwise.They're also just ordinary drivers, with no advanced and blue-light training that we are privileged to enjoy.
Hence, I just let it go with good humour, and if I feel like uttering a comment to my crew-mate, I usually say something along the lines of 'forgive them, for they know not what they do!'
kurt535 said:
what's the general concensus arriving on scene to find a first responder? positive or 'oh no - here we go'....
I see the hidden meaning in this question and I do find that some ambulance staff don't recognise the value of first responders, and are even quite rude to them, when arriving on scene to find one present. In my opinion, this is completely unacceptable.The simple fact of the matter is that, everyone working in any kind of healthcare capacity, are part of the family of people striving to assist folk that are in a time of need. This extends, for instance, from the grass roots of the teams of cleaners quietly going about their business in hospitals keeping the environment clean and safe for us all, right up to the big-shot consultants, and everyone in between.
First responders are choosing to give up their spare time, in order to one day, maybe make a difference to the life of a patient and their family. They are as valuable to me as anyone else who might be available to support me on a scene.
Their value is totally beyond question in cases of cardiac arrest where they may arrive before me, and are giving really good quality CPR in line with their training. Those vital early minutes of CPR in cardiac arrest patients - especially younger ones who may be down due to a reversible cause, make a huge difference in terms of out of hospital survivability. Simple as that.
In less serious cases, they still provide me with an early snapshot of history and presenting complaint when I arrive, which helps to shorten my 'on scene' time. This is a performance metric which the trust is measured on, and has a bearing on funding, so again - the first responder is delivering a useful resource, which does not cost the trust anything in financial terms but delivers a possible saving.
I have never come across a first responder who is not keen to learn, and enjoys what they are doing - so I engage with them on scene as much as I can, thank them for their support, and if I have time, will explain to them any technical or clinical information relating to the patient, for their own personal clinical development. They are always very grateful to me for that, I find.
It's a team effort, this healthcare thing, and we should all recognise that. We're all fighting hard against a lack of time and resources, hence any assistance is gratefully received as far as I am concerned.
Ruskie said:
Excuse the Daily Wail but this quote made me laugh ????????
‘This Morning's resident GP admits he was left 'broken' after his 12-hour shift as a paramedic saw him fail to save a life, treat stab wounds and comfort grieving relatives’
Or in other words a normal day at the office for Ambulance staff ??
http://www.dailymail.co.uk/health/article-5298543/...
Lol exactly. I occasionally have an 'observer' out with me along these lines - someone from a hospital, or a call handler. Almost universally, they say something along the lines of 'I have no idea how you guys do this every day...'‘This Morning's resident GP admits he was left 'broken' after his 12-hour shift as a paramedic saw him fail to save a life, treat stab wounds and comfort grieving relatives’
Or in other words a normal day at the office for Ambulance staff ??
http://www.dailymail.co.uk/health/article-5298543/...
Occasionally I sit and reflect on my job, and I have come to the conclusion that it takes a special kind of weirdo to want to do it!
Ruskie said:
The_Doc said:
Z064life said:
I've seen some pretty graphic injuries on tv but how can you manage to not only see them but actually rectify them? I.E. dislocated knees, broken legs, etc.
Everything becomes normal once you've seen it a few times. The most important skill is empathy, not sympathy. You help the mangled, not by feeling their pain, but by acting in their best interests, giving pain killers and managing their affliction. It's a type of detachment.There is no dislocation/fracture/evisceration that causes the healthcare professional pain, so he/she switches to training/experience and picks them up.
Also, things are much much more gory in the operating theatre! Wait until I start taking things apart, to put them back together. Who's bothered about a few bones poking out the skin ?
Apologies for thread hijack....
The_Doc said:
Yes ouch.
I respect all paramedics, but you a little less now.....
Just as long as you don't drive around with a green light on the top of your car....
"what's that green light in my rear view mirror? Is it the on-call butcher? "
All paramedics are brilliant in my view. I witnessed a big smash at 6:30am a few years back. T-bone RTC Jaguar vs Fiesta. The Jag man walked out easily and I parked up and rushed over to Fiesta boy, who was unconscious over his steering wheel, chin down. I held his airway open for 20 minutes as his GCS improved from ?4 to perhaps 13. Fire engine came at 20 mins and ambulance at 23mins.
It was about minus 3, I had no equipment and the car (and us two) were in a ditch in 6inches of mud.
So I have respect for all pre-hospital staff.
I sort of know what Ruskie is getting at - in any job or profession, there are always one or two people who spoil it for the rest of them! In my experience, regarding A&E docs - I could count on one hand how many were a bit 'billy big balls' and treated us (and nurses and indeed any subordinates) with contempt. It's pretty rare though, and I am happy to say that the vast majority of Docs I liaise with, are top men and women. I respect all paramedics, but you a little less now.....
Just as long as you don't drive around with a green light on the top of your car....
"what's that green light in my rear view mirror? Is it the on-call butcher? "
All paramedics are brilliant in my view. I witnessed a big smash at 6:30am a few years back. T-bone RTC Jaguar vs Fiesta. The Jag man walked out easily and I parked up and rushed over to Fiesta boy, who was unconscious over his steering wheel, chin down. I held his airway open for 20 minutes as his GCS improved from ?4 to perhaps 13. Fire engine came at 20 mins and ambulance at 23mins.
It was about minus 3, I had no equipment and the car (and us two) were in a ditch in 6inches of mud.
So I have respect for all pre-hospital staff.
Indeed going further, I often summon up the assistance of HEMS which normally arrives with at least one hugely experienced Doc....and in my patch, I'm even sometimes lucky enough to get a well-known and widely published consultant professor turn up. I've never had any attitude from any of them, in fact the opposite - they give me 100% attention and take my handover and clinical assessment with complete professionalism. For example, if I say to them 'I think this one needs an RSI...' then an RSI I get.
Good of you to say such kind words anyway, thank you. And don't ever drive on by if you see an incident - we're always grateful for any off-duty assistance given before we arrive, from you guys. As for respect for us - as I said a few posts back, I think we're a special kind of strange people to do this job. We love it, for some reason. Go figure as they say!!
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