So Long, and Thanks for All the Fish

Folks.

I've decided to conclude this blog.

It's has been a good ride, an excellent journey and thank you for all your support, your comments and the friendship. I have not met most of you but I have been inspired by your stories, your experience and I look up to your experience or your youthful optimism.

It has been a privilege to share my life with you over the past 17 or so months as I slowly learnt the ropes of being a qualified Paramedic. It has been one hellya of an adventure - I've had my ups (So close yet so far), I've had my downs (My stuff up), and the just weird and strange (Machines that goes 'bing').

However, I've been given a new opportunity, one which I mustn't give up on. Increasing difficulties of keeping patient confidentiality and issues at work has also partly contributed; and whilst I love the blog, I need to keep it in perspective.

Please feel free to keep in touch; the Facebook page and the email address should still be working. There's also another blog, but this one is a bit more laid back and generic. Please feel free to email me, if you wish - outbackambo (at) gmail (dot) com.

So Long, and Thanks for All the Fish.

OA :)

Plenty

Have you ever gone without?
Not for a day, not for a week;
Have you ever been denied the stuff of life indefinitely?
I haven't. Taps always run water for me, hot or cold.
Food is never far away. Good food, clean food.
I needn't catch it, forage for it, disinfect it, queue for it.
I always have shelter. Always a roof. Always warmth.
Sure, the roof may leak, I may get cold - but this is the exception.
I have plenty.
A friend is never far from me, nor company, nor love.
I have many who make me feel special, needed, important.
There are many also to whom I may return this favour.
I have family. Siblings. Parents.
I of their blood and they of mine. We share, we laugh, we fight,
we cry; we love.
Lucky me.
I have freedom. I can change my life and make as much or as
little of it as I desire. With the gifts of determination and passion I
have the power to realise dreams.
Many of us do.
If you, unlike me, have truly been without, I salute you.
If your throat is parched and dry with thirst, if you cry with joy
when food is available, if you shiver at night with bitter cold; I hail
your courage.
If you have ever been alone so absolutely that you ache, or
denied a family by events beyond your control; my heart aches
for you.
If you are bound into existence that you do not desire, with no
hope of realising even the most modest of your dreams; I pledge
to help you.
I do not know you, but I know you are there.
I have plenty. Enough to share.

Dr James Fitzpatrick

ACAP conference

Just came back from the ACAP (Australian College of Ambulance Professional) conference hence I’ve been away for the past few weeks.

It was a good conference that were largely based on research (academic) papers on the latest research into the Emergency Medical Services, the EMS profession in other countries (especially the UK / London Ambulance Service) and registration. The latter, registration of Paramedics, was a huge aspect of the conference as currently in Australia, Paramedics are not registered so basically anyone can call themselves a Paramedic - from someone holding a first aid certificate, or completion of a 10 day Industrial Paramedic course, or someone with a Diploma / Bachelors degree working for a statutory state/territory ambulance service.

It was great to network, see some new equipment and being open to new ideas.

Well done especially to the NT ACAP committee on making this a possibility to our service! It was great, thank you and I look forward to the 2010 conference in Perth, Western Australia.

--------

Thanks for the comments to my last post on defibrillating the pulseless electrical activity (PEA) in idioventricular rhythm. No, it was not a case I attended but it was a case that was discussed and hence was looking for secondary opinions. Often the case that as a group we become quite insular and set in our ways, hence it was great to get the opinions of others, from other services and places!

Thanks heaps for contributing all - it was an awesome learning experience!

Clinical pondering - Defibrillation

A patient is in cardiac arrest; unconscious, pulseless and not breathing.

Monitor shows an idioventricular rhythm of approximately 40 / minute.

Do you:

i) Defibrillate
ii) CPR
iii) Both i and ii
iv) Neither i nor ii

Would be very interested in hearing your thoughts.

Watch this space...

G'day,

The past few weeks have been increasingly hecticly filled with work, placmenets and courses which makes for looong days.

But OA will be back on board with more stories starting tomorrow.

Watch this space!

On other news, check out EMS1.com site - it's got quite a good list on Ambulance and EMS stuff, as well as a featured blogs featuring Australia's very own flobach republic.

Keep safe.

OA

Thoughts and prayers

On 30 September 2009, the island of Samoa, American Samoa and parts of Tonga was struck by a tsunami caused by an earthquake near Samoa.

On 30 September 2009, an earthquake in Sumatra, Indonesia has resulted in significant casualities and damage.

Both natural disasters have resulted in significant loss of life, resources and incomes.

Australia has been forunate to be in a position to provide assistance and I was chuffed to have been asked to head to Sumatra by an external agency. However due to current work staffing pressures, it has not been possible to be released from work at this stage for the Phase 1 response.

Collective thoughts and prayers to the victims of these terrible disasters.

First aid training

Since getting back, the last few days have been hectic as I'm currently trying to obtain accreditation as a first aid instructor. As I mentioned previously, my original training way back when was in adult education. However, not having been in the field since my undergraduate degree and work from years back, I was naturally rusty with the class interaction and teaching skills.

Hence it (partly) prompted my interest in obtaining accreditation as a first aid instructor. It's also a nice thing to have; provides an opportunity to help volunteers by teaching courses; and lastly potentially another source of income (though this is a very distant consideration since first aid instructors aren't paid all that well compared with ambulance work).

It's handy also working for the same organisation since St John Ambulance NT is the largest provider of public first aid courses in the Northern Territory.

The accreditation process consists of a number of steps which normally takes a month or two if employed full time, or a year plus for yours truly:

• The trainer must have completed the Certificate IV in Training and Assessment (or previous Certificate IV in Assessment and Workplace Training); as well as a current HLTFA301B Apply First Aid (Senior First Aid) certificate
  
• The applicant then applies to St John Ambulance seeking accreditation
• If approved, then the applicant is assigned a mentor for the accreditation process
• Observation of a minimum of 2 full HLTFA301B Apply First Aid courses
• Completion of an accreditation assessment (practical and theory)
• Completion of co-delivery of a number of HLTFA301B Apply First Aid courses
• Final assessment of a full HLTFA301B Apply First Aid course
• On satisfactory completion, then the applicant is recommended to go "solo" for accreditation to the HLTFA301B Apply First Aid level
• Additional advanced first aid course levels (up to Industrial Paramedic) can be completed with participation and co-delivery of the various courses in a similar accreditation process.

It's a long period and I'm currently up to the final assessment stage which was what I've been involved in the past 2 days. It's been good; my mentor is excellent and the course material was familiar. The challenge was a class full of English as a Second Language school students which made some of the explanation of concepts interesting. Assessment also proved interesting.

2 good days - hopefully I'm recommended to go "solo"...

A country relief - Chapter 1, Episode 6: Back to Darwin

Well Katherine is over. It's been fun actually, something different and learnt a lot. My partner has been awesome to work with and there's been a few unforgettable Kodak moments during my time. I definitely won't be forgetting the huge swarm of fruit bats that comes out at dusk; nor the buffaloes by the side of the road as we did a country transfer; or the infamous ghost of the centre.

A few pictures of the morning of the last
night shift and the drive home for you to enjoy.


(Above Left: Bubble bath, Ambulance style)























(Above Left and Right: These two pictures were of a fruit bat we found on the road. S/he had broken its wing after colliding with a road train and was "crawling" around, obviously in a bit of discomfort, so we rescued it and took it to the local animal refuge)






(Right: photo taken on the drive back up to Darwin on the Stuart Hwy. These two road train trailers carrying hay bales somehow caught fire and destroyed the trailer a few days ago. And yes, those are the Grey Nomads to the left of the screen as mentioned here).

A country relief - Chapter 1, Episode 5: On dodging water buffaloes and kangaroos

Part 1:
Last night shift was met with an earlier than expected call in. I was in the middle of carving my very first roast that I cooked (very proud of myself here, except I burnt the potatoes a bit... oops) when Comms kindly rang and advised of a pending 'track' job (ie. very remote country job). This time it was to meet with the clinic ambulance of Jilkminggan community, which is about 147km south east of Katherine with a population of 170-290 people (Some info here, 14o57'20.13"S, 133o18'14.18"E if you want to see it on Google Earth). For those whom have been to the Northern Territory, dusk and dawn are the most dangerous times to drive as nocturnal animals are quite active during this time, resulting in many roadkills. That's fine if you're a big road train with 4 laden containers on the back; but for anything else, its a whee bit dangerous - bull bars fitted or not.

So we start driving VERY cautiously south bound and hardly going anywhere near the 130km/h speed limit.

The transfer was rather uneventful - it didn't take as long as we expected.

Total count: 21 skippies; 3 water buffaloes.


Part 2:
1:30am. The phone rings. A weary voice on the other end announces "Code 2, Katherine Gorge". Great.

Katherine Gorge (Nitmiluk as it is known traditionally in the local Indigenous language, see this National Park site) is about 30km north east of Katherine and features a magnificent set of natural deep gorges carved by the Katherine River in sandstone. This weekend also marked the 20th anniversary of the handover of the national park and area to the local Jawoyn indigenous peoples (see local media reports here).

So we pull our shoes on and off we go for the trip down to the gorge.

Comms comes alive on the road.

"Roger Car x. If you can now proceed to the Visitors Centre of Nitmiluk Gorge. There you have a 21 year old male patient, with a laceration to his big toe, post a week ago. You'll be on case number 12941, at 0133, your code is 2".

Great. It was my job too.

As we drove down the very dark and lonely road, a big red glow illuminated the horizon off to the south. As we drove further towards the gorge, the glow grew slightly - it was a fairly big bushfire. Glad I'm not the firies.

Fairly unremarkable job. The patient had cut his toe on a glass bottle over a week ago and was unable to sleep. Shrugs.

Total count: 18 skippies, 5 water buffaloes (including one near suicidal one), 2 cane toads.

The drive home tomorrow.

PS: The ghost was fairly well behaved last night; only a small cold gale every now and again.

A country relief - Chapter 1, Episode 4: The ghost of Katherine centre

24 hours off as we swapped from day to night shifts. Saturday heralded the town markets, featuring the usual food stalls, bic-a-bracs and arty items. Not a shabby little outfit, nice community atmosphere.

The night shift started with a nice fractured clavicle following a local footy game. Methoxyflurane didn't touch the sides, intranasal fentanyl helped slightly but it still painful on the bumpy way in. It turns out that there are no afterhours radiology (Xray) service at Katherine hospital emergency department, so the poor bloke was sent home with Panadeine Forte (Paracetamol and Codeine Phosphate) and a sling with instructions to come back during the day. Ouch.

The rest of the night was steady, with a few jobs here and there. Even time, thankfully, to 'rest and recline'. I opted for the computer room and onto a stretcher mattress (odd, but comfy enough). During this period of 'rest and recline', I had the good fortune to meet the Katherine centre ghost. She's a bit temperamental - at times she's noisy, other times she's quiet; sometimes she's cold, other times she's quite hot. It was initially quite disconcerting to have a blast of cold air near the face (which scared me to no end), followed by a warm breath. I've been told she's harmless, just annoying... we'll see how the next night shift goes.

The last job of the day was an electrocution. Unfortunately, he was DOA (dead on arrival) and there wasn't much we could do, so we just left the body hanging for later disposal. The local dog had a bit of a sniff around too but didn't seem particularly interested.

A country relief - Chapter 1, Episode 3: Planes, Patients and Personalities

I'm half way through... doesn't really seem like it.

Today was a bit less hectic than the first day and I got to appreciate the finer ways of life at Katherine ambulance centre.

It appears they have a strange ritual around the crew room or in the kitchen. I don't think there's an official name for it... so let's call it Swat-the-mosquito-competition. For some odd reason, Katherine centre is filled with them. There's no real bodies of water nearby (except for the river, but that's a fair way away) and the centre is fairly clean. The mozzies just seems to... breed... and multiply. So it seems the local ambos partake in the swat-the-mosquito-competition, and some take it fairly seriously keeping a daily death count. Phrases like "You stunned 'em", "Close!", "Ha!! Gotya" and "Where'd that [insert word] go?!?" seem to have entered the local ambo vernacular.

Daily ritual aside, we weren't terribly busy today. Lots of Airmed transfers (from the hospital to the airport onto an awaiting KingAir aircraft and onto Darwin for further investigation or treatment).

The airmed transfer in the afternoon was almost the highlight of my day (coming a very close second to the Katherine-mozzie-ritual). My partner attended to two patients whom was transferring to Darwin for further treatment. One needed surgery on some damaged nerves; the other was an elderly male with acute confusion with ? TIA (mini-stroke) for further investigation up in Darwin.

This was my first drive out to the airport, as the other times I was in the back attending. Naturally I was a little nervous as the airport entry is on a little outback road off the main highway with no lane dividers and one sign. After a bit of prompting from my partner at the back, we managed to get there.

But something didn't look quite right. There were too many planes there. Katherine is not a big place and is not a destination by commercial airlines. Yet as I pull up to the gate to the tarmac, I see a QANTAS B737-800, a Jetstar A330-200 and an A340-200. Weird. Their doors were shut, yet passengers and crew were still inside, just waiting. A tanker and a police vehicle stood nearby.

The normally-largest-plane-around-but-now-very-much-dwarfed Kingair sits nearby and as we pull up, the pilot sees my quizzical look. He later explains that an aircraft had issues at Darwin Airport which forced the closure of the main rainway, hence commercial services were diverted to Katherine.

The loading of the patient needed the surgery was uneventful, but as we attempted to get the elderly male out, he blankly refused. His issue - he wanted to go home (to a community about 500km away from Katherine). Yet obviously he couldn't as he required further medical investigation which was not available in Katherine. No amount of logical explanations, convincing, trickery nor coaxing managed to get him out.

My partner tried. Nope.
I tried. Won't budge.
The airmed nurse tried. Uh-Ah.
The airmed doctor tried. He refused to talk to her.
Even the pilot tried and a look which could break glass resulted.

He was confused, yes, but he was still compos mentis. We couldn't just kidnap him onto the plane; we could not just sedate him either; nor could we "section" him - ie. make him an involuntary mental health patient.

That made things difficult.

The airmed nurse was getting impatient and rather unhappy. The pilot didn't seem to mind, but his daily hours were ticking down. The doctor locked herself away in the hanger office ringing the hospitals and District Medical Officer.

Several phone calls and 45 minutes later, the doctor issued an ultimatum to him - either come with them on the plane, or go back to Katherine.

He wouldn't get out of the ambulance, so we had to take him back.

Another interesting day!

A country relief - Chapter 1, Episode 2: The first day

Like any country towns, jobs are normally few and far between. Or you could get a rush of jobs.

I think I landed during one of these rushes.

Which actually works out well in my opinion, I get to see a lot more of town! My partner is very laid back, fantastic to work with, great with patients and very knowledgeable - great to learn from.

7 jobs today, all legitimate surprisingly.

I better clarify... what I meant by legitimate is transport for an acute medical reason - so stuff like a systemic infection, shortness of breath or a stroke; not stuff like a stubbed toe, wanting to get out of the rain/cold, or just wanting a lift somewhere close to the hospital.

A funny little job though.

My partner attends to a postictal patient as we drive to Katherine hospital. He's not known to her, which is unusual in a small town like Katherine. Like many postictal patients, he is a bit agitated, confused and tired. The oxygen seems to do its work as he starts looking around.

The transport doesn't take long; it's not a big town.

As I pull up to the hospital, he sits bolt upright and takes off the seat belts. Guess it makes my partner's job easier... we'll just walk him in.

I open the door and sure enough, he starts to climb out. My partner guides him over to the hospital entrance but he just stands there.

Without prompting, he starts breakdancing.

He does the robot, before launching into the invisible-pull-the-rope-forward dance, followed by the moonwalk.

The triage nurse walks out, wondering why it's taking us so long to bring the patient in. She interrupts right in the middle of the hand-vibrating-on-the-invisible-wall routine. She clicks and asks him to do the moonwalk - all the way to the hospital bed.

A Kodak moment but definitely made my day.

(The patient got discharged a little while later).

A country relief - Chapter 1, Episode 1: The drive to Katherine

I've been fortunate to have the opportunity to be sent on a country relief to Katherine for a block (2 days, 2 nights). Katherine, for those who are unaware, is not just the name of a girl but is also the name of a town about 320km south of Darwin. With a population of just over 9800 (according to the Katherine town council), it is the 3rd largest population centre in the NT outside of Darwin/Palmerston and Alice Springs.

The drive down wasn't too bad. Not too many grey nomads thankfully. They're not that bad... really... just annoying to sit behind at 100km/h towing a caravan in a 130km/h zone.

Here's a pic of my travels down the Stuart Highway where road trains and weird cargo abound.

CPR training

In another life, waaaay before I did ambulance work, I was an adult educator. Scary thinking about it actually.

So when Impacted Nurse wrote up this article, it got my attention which combined my interests in adult ed and pre-hospital care.

Milk Bottle CPR