SA_Medic

Well, I reckon this mail will direct bearing on myself in the very near future. I am awaiting the final details on my possible position in the tourist areas referred to in the above mails. I am not 100% sure whether it will be Iraq or Afghan just yet, I should have those details closer to the time. AK, if I'm in your area I will most certainly be looking for you. I can't play poker but I'm a fast learner. Other than that, I agree with everyone here. Keep safe out there boys and girls, everyone back home (which ever country you are from) is waiting and rooting for you tome come home as you left. Breathing and smiling! Rgds S

Oh wow, thank you Ter. I will be in your debt for ever!

I have one tattoo and this would be it

Excellent, I am glad to see that's one thing that hasn't changed in the last 4 years.

Ah damn, that sucks. At least it did turn some really cool pictures. I am glad you doing good on the quilt. I can't wait to see photo's of it.

Oh wow, that's still going? Amazing, I still wanna see a photo when it's done. What ever happened to the travelling bear?

Evening folks, It pains me to have to go through this again, but alas I do not have a choice. I am in need of your help, I had a really nice patch collection (147 at least) built over the better part of 8 years which sadly got stolen together with the Shield (the one you carry in your wallet in the US) when they decided to "redistribute possessions" during the night. I had some really nice ones, collectables from NYC commemorating 9/11 etc. No I am starting from scratch with the collection. Unfortunately because of this, I have no patches to trade for those of you willing to assist me in getting the collection back. If you are able to help, I will be forever in your debt. I will PM my postal address to those willing to help. Thanking everyone in advance Regards S

Now I am curious as to the explanation on how the cat and husband fits together on cheating.....

I was about to ask if we should arrange a room. lmao I never got round to checking the fontanelle, I can not comment on tears as there was virtually no reaction to me checking the child out.

Welcome, As Fire Medic said, search the forums to see if the question has been asked before. We're a pretty helpful bunch (for the most part) and will gladly answer questions.

I am seriously glad to see I am not the only one that's had to listen to some weird ass things on the phone

Happy Birthday guys, May the day be filled with wishes and dreams come true for the both of you and the best of the past year be the worst of the year to come Regards S

Today I was standing around at the office and answered two calls in the Alarm Centre (Dispatch). It was enough to make me decide to never answer that phone again. Call number one: Me: "(insert company name) How may I be of assistance?" Caller: *crying* "May I speak to the paramedic on duty please?" Me: "Sure ma'am, I am the paramedic on duty, how may I help?" Caller: "Could you please explain to me how to commit suicide?" Me: "Excuse me?" Caller: *still sobbing* "I want to commit suicide and would like to know how to do it properly" Me: "Why would you decide to take such a drastic step" Caller: "You are of no help at all" and she hangs up, I can't call back no telephone number on display. Call number two: Me: "(insert company name) How may I be of assistance?" Caller:"Hi, I need an ambulance" Me: "Sure ma'am, what seems to be the problem?" Caller: "It's a slightly delicate situation, but please ensure they have a body bag with them" Me: "Ma'am, if the person is dead I will have to send the police out as well. Please explain the situation to me" Caller: "It's my husband, and he's not exactly dead yet" Me: "Yes, go on" Caller: "He has been receiving radiation therapy and has since been going invisible. Monday he received a really high dose and is now completely invisible. I have him locked in the bathroom at the moment" Me: *trying really hard not to laugh* "What is he getting the therapy for?" Caller: "Oh, and have the ambulance bring a black light with, it's the only way you can see him" Me: "Why is he receiving the radiation therapy ma'am?" Caller: "Oh f%^k, he's out of the bathroom. I will phone back as soon as I have him locked in again" and she to hangs up. The weird people are out today!

Apparently you still need some more of your legal pain killing stuff (BTW, what labels do you get there?), you're still sharp as ever. I will most certainly be watching this topic.

I can't believe you still have the "be all and end all" instructors in these days. Would you really be thrown off the class for correcting the mistake? I mean seriously, being an instructor I welcome comments and criticism. As a student paying for the course (?) you have the right to getting the (correct) information that you are paying for.

tniuqs dude, I would have done the same if not slightly worse. I am not nearly as "diplomatic" as you seem to be. I would probably have told him in his face what I thought of him. This simply amplifies my thoughts that people no longer practice medicine because they want to, it's simply a job these days. Hope you get sorted quick dude.

True, I did entitle it that way and I did ask for your thoughts. I simply disagree with the postings on deciding when to give the child the benefit of the doubt because of quality of life. We all know babies (especially girls) have more fight in them than adults hence the decision to "terminate" would be easier on adults than infants. My question would be, who teaches you to decide on what acceptable quality of life and what not? There's no universal accepted standard for quality of life? Is it based on your specific area where you live and make a living? The one thing this thread did emphasise is that there are huge gaps in the way we do things all over the world (a gap that does not seem to be closing at all). The gap in training and equipment availability is just as huge and ever increasing. I enjoy this type of conversation, it's borderline "getting personal and confrontational" and still teaches at the same time. Like probably 99% of the people on this site, I enjoy the expressions of views and interest in cases and scenarios like this. Update on the patient: According to the treating paediatrician rehydration is doing the trick and the process of re inflation of the lung has started with the vitals and saturation looking better.

While I take all views into consideration and understand the views of everyone here. I do not agree with some of the postings related to this case. The sad reality here is that the government hospitals are severely under resourced as is the government / city run ambulances. Small things such as c-collars, vacuum mattresses, even transport incubators are non existent. If at all possible, I would have taken photo's or a video or something to show you that state of this and other government run hospitals in Africa. I am by no means trying to make excuses for what I have done (whether it be right or wrong). What I am saying is assuming that this baby has had any type of decent medical care while spending the week in the hospital or that the doctor has in anyway communicated with the parents what is being done would be very very optimistic to say the very least. I have learned the hard way to expect your worst nightmare come true when you get called to transport any patient from the government run hospitals in Africa. More often than not, the patient was taken there by the family on loaded onto the back of the police pick up truck (the government ambulance service isn't available). The casualty department (don't even try and think your trauma units) has seen the patient, decided they are not up to working today and this patient will be fetched by us shortly so they just don't do anything. Neither quality nor value of life is taken serious here. For most medical staff in these facilities it's a salary, nothing more and nothing less. In a recent newspaper article (I will try and find it) this same gvt hosp made the news for not seeing to a 2year old child resulting in the death of the child. As explained by the paper "The child was put to bed by her mother, the mother went into another room of the house and heard the child cry. When she entered the room she found a cobra on the bed with the child having been bitten on the head. A neighbour killed the snake, loaded the child and mother into a taxi (no ambulance available) and rushed them to said hospital. Upon arrival they explained the situation to casualty staff and showed them the snake. The mother was told to join the queue of 30+ people and wait their turn. When the child started haemorrhaging from the ears and nose, casualty doctors realised the child was sicker than they though. However, it was to late and the child died". Value of life is my foremost and only concern in this country. Unless there's a specific DNR I will give my patient (regardless of age) the benefit of the doubt. If you have not learned in the first 3 years of this business that doing your best with every patient might just change their life, then you never will. Sure there's cases where a resus has to be called which I do and cases where starting a resus is plain and simple not even a viable option any more. However, if for any reason I feel the patient might still have a chance, I will give him / her that chance. I did not spend the money nor time on becoming a Paramedic and all the other abbreviations to stand "play God over life or death". I did this because I wanted to be a paramedic and wanted to give all people the chance at life *let the flaming begin*. Cliché as it might sound, but that's my view on this patient and every other patient I have and will see in the future. I will post an update on this case later today as I am going to the hospital for a follow up.

As a follow up on this, I have now managed to convince the powers that be that I am in fact allowed to Instruct and got tasked with setting up the training facility. This however proves harder than anticipated. I have logged 12 mails and countless phone calls to Dallas (AHA) to try and get the info and requirements to have the facility set up in such a manner that we will be AHA approved. Does anyone know the requirements to have this done? I will be eternally grateful if anyone could help, even if it's just with a direct contact. It seems the moment they hear Africa they run for the hills and hide!

@Vent - Oh, that type. Nope none of that that I am aware of in the whole of Africa. @Kaisu - Nothing confrontational or derogatory meant towards you mate, it's just me being pissed that the technology and know how is out there but takes more than a few light years to reach us here on the dark continent. As you said, we do everything in out power and knowledge to ease our conscience and hopefully save a life or two along the way.

I have no idea what the doctor told the parents. I arrived at the hospital finding the mother who does not speak, read or write any language myself or my crew understands. In South Africa we have excellent facilities to manage this type of case, sadly in Namibia there's none. I'm awaiting the phone call to tell me to fly this child the 4 hours required to South Africa, which I will most probably refuse to do.

Apologies for the delay in my reply, Monday's at the office is at best a day to have rather stayed in bed. Also apologies for not giving more information on this case, I was slightly more than a little pissed at the initial medical treatment and facility. Starting at the beginning (and I wish I could show you this medical facility and it's staff). The only information we had at the time of dispatch was that the child (male) was born 2 months prem and is now 2 months old. The parents were unhappy with the current treatment being given at the Government facility and wished to have the child transported to the private facility 5min down the road. On arrival I found the following: 1) Baby weighing 1.2kg (slightly less than 3lbs)on CPAP, 2) Severe dehydration (evident by the loss of tugor on the abdo and calves) 3) Cyanosis (particularly evident in cranial area and the chest) 4) On palpation the child was cold (to the extent of my sats probe did not detecting anything, warming the baby with the warmer blanket helped) 5) The baby was not crying nor showing any normal / expected response from being examined 6) Auscultation revealed a rub of right and no audible air entry in left (PDA question: No murmur audible) 7) Resp: Rapid (-> 60/min) with deep suprasternal retractions 8) Pulse rate: 67 (as mentioned in initial post) 9) SATS: 56% on CPAP (as above) 10) IV insitu ® arm. 11) BP 50 systolic 12) Lymph nodes small and palpable No labs nor any xrays were available (according to the treating doctor and nurse) The treating doctor informed me that the child was admitted with pneumonia and has received no medication / antibiotics to treat the infection. The only treatment that was confirmed would be the CPAP and IV (as mentioned). This is when I decided to intubate with a 2.5 tube and ready for CPR. I confirmed (as required) tube placement via auscultation (still no audible air entry left) and started bagging. With the stats going up and the HR increasing it was evident that no compressions would be needed. Thus we transported to the receiving facility while informing them that we are inbound and need an ICU bed. As mentioned earlier, chest x-rays were taken at the receiving facility revealing the pneumothorax of the left lung. I have not had the time yet to follow up with the paediatrician but will update you as soon as I have had the chance. In reply to CH - True, we have three levels of qualification in SA. 1) BAA (EMT- which is a one month course or 3 months part time 2) AEA (EMT-I) Three months full time (only attainable if you have 1000 pt care hours documented, passed the entry exam and obviously the course) 3) CCA (EMT-A) 12 month full time (only attainable if you have documented 1000pt care ILS hours, passed the entry exam and the course itself) The CAA / Paramedic course has changed in recent years allowing a school leaver to do a National Diploma via the Univ. No road experience required, yet after 4 years you walk out a Paramedic. You can then go and do B-Tech, M-Tech and D-Tech in Emergency care. The first two levels have a "under supervision" license whereas the rest have a "unsupervised" practitioners license. No doctor needed, nor any medical consult needed before administering meds / drugs as per protocol. In reply to Kaisu - I am in Namibia, how does a situation like this develop? Probably the same way a doctor flies a pt to my city indicating she had a CVA that's visible on the ECG! I do a check and low and behold, she's had an anterior infarc (I will scan the 3lead print out when I remember). In reply to Vent - I hope we use the same abbreviations here as you do over there. PDA question, see above for answer Probe was post ductal as you will no doubt have noted from my post above. PMI - Apical Pulse? If so, there was a shift to the right Sadly we do not have the "paediatric specialist" we can call to jump on our vehicles, nor am I allowed to ask for a x-ray to confirm tube placement. It's a resource that's bolted to the floor of the Govt hospital (some do not even have x-ray facilities). I so wish I had the facilities and resources you have across the waters. We still have to tube, confirm tube placement via auscultation, stabilize, load and go. This makes for interesting conversation though and helps keep me on my toes and dreaming. Keep it coming

Government hospitals are completely government owned, run and funded. These hospitals in most cases would be on of those places where I would grab my IV stand and ride it to a PVT facility. Mostly due to slack staff and shortage of equipment. Private hospitals as exactly that. Privately owned and funded by the medical insurance of those that get admitted. The doctor's here are mostly GPs and Specialists (who coincidently does hours at the Govt Hosp) with the nursing staff being old Govt employees wanting a cleaner facility to work in as well as higher salaries. Although, not always the sharpest knives in the drawer either....

Let me give a description of the events then I ask you for your thoughts. I received the call via our Control room asking me to do the inter-hospital transfer of a 2month old, premature (born 2months prem) baby from. We could not get more details as this child was laying at one of the local government hospitals. So off we go, ready to transfer this child to one of the private hospitals. The only thing we know for sure is that the father of the child wants us to transfer him. The current treating doctor sees no reason for the transfer. Normally we will not oblige something like this as it's against company policy to transfer a patient without the treating doctor doing the necessary paper work. Upon arrival at the paediatric ward, we are greeted by a somewhat uncaring nurse. I do the normal "Hello Sister, how are you?" bit only to be pointed in the direction of the doctor with a grunt. This is when I feel the air temperature, and decide it might be a good idea to zip up my jacket. The doctor walks me into a room filled with about 20 babies, I might as well have walked into a freaking freezer! I get to the side of the bed and find a small, blue skinned little boy on CPAP. The doctor start talking and explains the child was born two months prem, two months ago and admitted a week ago with pneumonia. I look at the IV and all I can see is a Saline on a dail-a-flow. No meds, no antibiotics. Just that one IV. Asking the Doctor if what meds the child had I am told the Saline. I ask again, just to make sure I ask specifically. "Has the patient received any medication?" To which I am told:"No, just the saline". I connect my monitor to check vitals and find the following: HR: 67 Sats: 56% (on CPAP) To this I ask the DR if the child has always been this brady. The reply will shock you:"He's sleeping, so it's normal". At this point I feel like killing this DR but, decide to rather do what I am paid to do. I sedated the child and tubed him, with the bagging the HR goes up to 120 and the stats increases to 93% where it sticks. I can't get it any higher, so we leave and transport to the receiving hospital. I inform the control centre to let them know that we are inbound and need an ICU bed and no longer a normal bed as arranged. At the receiving hospital, they take chest x-rays which reveals a complete collapsed left lung.... How would you deal with this?

Just throwing this out there in the hopes that someone might have had to go through this. We are in the process of getting a training facility sorted here (the only in the country). After various discussion, it was decided to rather try and get AHA approval for this facility. Up till now, all I have received was a run around when phoning AHA. Does anyone on this board know what the procedures, costs, hoops etc would be to get our facility approved? Thanking you all in advance S