Timmy

I always try to divert the conversation with the general public when they start asking questions about EMS, what you do, why you do it ect. It’s hard to explain to people who have no idea or find it hard to comprehend what you’re trying to say. It’s a lot for some people who have no idea what EMS is about to take in. I guess in a similar sense people always ask why I volunteer, I have no direct answer. I like it, like the people I work with, enjoy the different experiences and I learn a lot. I work 40 hours a week in the hospital, attend school part time, study then volunteer in my spare time, sure some weeks can be non stop but I can think of nothing worse then sitting in front of the TV or just doing nothing. I think working in the Middle East or overseas would be awesome, once in a life time experience. I hope that once (or should I say ‘if’) I get qualified and gain some experience I could think of nothing better than working in a totally different environment, with people/cultures/countries I have no idea about. I’m doing my nursing training in a small rural community which I grew up around, we have such a nursing shortage it would be so easy to just keep working here in the little sub acute hospital that sees predominately the same type of patients day in day out with the occasional challenging patient that just gets transported to the RTC as quick as they came in. To me, places like this are for people who want to retire, it’s an easy going job and the pay is alright. There’s a lot more to life then sitting around doing the same thing. Your lady has limited insight into what EMS is about, sure the EMS system were she lives may be a little off target, is there a reason her ambulance is undermanned? I don’t know enough about this place to be making judgments.

I don’t live in NSW but I do agree, paramedics should not be rescue officers. In my state of Victoria which borders NSW we have State Emergency Service who provide road accident rescue to rural areas and the Fire Brigade who cover metro areas. Ambulance Victoria which is the state paramedic service have nothing to do with rescue, only patient care. Some paramedics may volunteer with an SES team but they would only respond when there off duty and do not respond in a medical capacity. This may be out of line but a lot of paramedics bang on about being understaffed, is it any wonder when you have paramedics responding in a non medical capacity?

The CT and Xray have come back negative, wouldn't spinal compression, herniated disks and stress fractures be picked up on this? When you say he drags his foot, is this dragging like a Shuffling Gait? He has no Bradykinesia or anything like this?

Well that sounds convenient... I'm not really up to scratch with blood tests in my 5 months as a student nurse but I guess an FBC because I'd like to see what the go is with haemoglobin, platelets, lymphocytes, WBC ect to rule out any infection or funky blood problems. Maybe even a tox screen. I'd like to do a full head to toe assessment. Does it reveal anything? Is there any oedema in the feet/leg? Is there any family history of anything like MS or motor neuron problems? What's his BGL like? No history of diabetes in the family? Has he had any wounds either visible or ones that are healed in the last few months? If so, did he happen to sustain this while climbing the tree, even a minor abrasion?

God, now your asking for trouble... Umm, I guess an X ray to start off with, doppler, tap on the knees for reflexes. If everything comes back ok then I may move to a CT of lower back and legs, maybe a blood work up. Failing this, palm him off to someone else for an EMG or similar lol...

Hmm... Quiet a challenging case. STI means Soft Tissue Injury and ?# is Query Fracture. I've had football players with similar complaints from sciatic nerve problems or a stress fracture in the shin. A tad extreme but is it possible he may have DVT or similar? Everything seems pretty crusiey for the time being, good circulation, still has movement, is able to walk, vitals are good. Not unless there is any deformity or signs of fracture I'm happy for him to walk to the ambulance if he is, if the patient so desires I'm happy to offer some analgesic pain medication if there's no contraindications. Unless things start to go pear shaped I guess there's really not much EMS can do, just a nice quiet ride to the ED for some pictures and further investigation.

Sweet, thanks for that. I've completed simliar assessments with a pen just never had a name for it.

What does point discrimination entail? I've never heard of it.

I take it he hasn't no cervical pain or spinal related complaints? Does he take any medication? Does he have lower back pain? What's our neurological observations looking like? No blurry vision, balance problems? Has he been overseas? Any past family history of cerebral or spinal tumours? Can I get a BP and Pulse please? Has he been playing sport, climing stairs ect? Any funny sensations on movement of limb suggesting a STI or ?# Does the limb actually have weakness/ loss of motor function or is he favouring it because it feels uncomfortable? Peadal Pulse?

You'll be right. Never think you know it all, always listen to what people say, be confident in the way you treat and speak to patients, never undermine the junior staff – offer to help them out and pass on some of your knowledge and skills, take every patient and situation as a new learning experience, let the junior and senior staff teach – everyone has different experiences, don't be afraid to ask for help or ask questions ect ect. I recently had a physician demand I get him a chair so he could sit next to the patient, his tone was very blunt and his generally a very rude and arrogant man but very good at his job. “You there, Nurse, Get me a chair” Needless to say this is not a good way to get my attention so I walked off. Don't do this lol. I'm sure you'll be fine.

Thanks guys. We did end up bumping him to 8lts after much debate between the RNs, NP and LMO. The hospital I work at is very small hence he was bumped over to the RTC about 40mins away. Since his trip in ED I’ve seen him on community nursing a few times as a hospital in the home palliative care patient. The AMI knocked him around a bit, his deteriorated some what, we think the METS are advancing but he has a LOMTO and doesn’t want to be diagnosed. It’s just a waiting game at the moment, pain control, symptom management and spending time with family and freinds.

I recently had a patient will the following: -59 Year old Male -AMI -ST elevation/Tacy Sinus -SOB -cyanosed around the lips -hx of pleural mesothelioma -?? Thoracic METS -COPD (C02 Retainer) -Emphysema (smoking) -Hypertensive - 02 stats sitting on 72% @ 3Lt 02 nasal cannula -Using accessory muscles. -Chest sounds clear + + -GSC 15 Basically, his screwed in the long term but was managing at home with ADLS and spending time with his family. His on an 02 concentrator at around 3Lt via nasal 27/7. Is quiet short of breath most of the time but he needs to use accessory muscles on excretion. My question: because his a COPD 02 retainer does he get more 02 than 3 Lts? There’s a lot of debate about this and I cant really find a clear answer.

While I haven't worked Christmas Day yet I have seen some things leading up to Christmas. On community nursing a lot of my patients are older and have dementia and a lot suffer from mental illness. I find the older patients have limited friends and family, some patients don't ambulate well and that effects the social side of life. I have a few patients that have no family or friends left. The thing that gets me worked up, some of my mental health patients are quiet young. There managing there illness well and are well medicated yet no one is willing to give them a go. I see about 5 patients under the age of 25 who live in one of those care houses. These kids are full of potential yet shunned by the community, half the problem with the kids is there to scared to go and get involved with life because of there past experiences out in the community. There family don't want to know them and pay for the accommodation in this community house because they feel embarrass to have them come around and spend Christmas with there family and friends. There pushed into this dark corner and no body wants to know them! Here's a little war story lol: One of my patients is 18, he suffers from mild schizophrenia and some autism, he sometimes has acute episodes. He is the nicest, brightest kid you could meet but his a little developmentally slow (but aren't we all!) . He makes me jealous, his a really good looking kid, blonde hair, blue eyes, 6'2 solid build. He could easily get a girlfriend but his autism prevents that. He suffers from extreme anxiety from past experiences being in the community and at school. I've read some of the horrible things his been put though by other kids while he was at school. I've never seen his parents, there not his NOK and every time you mention them he'll have an acute episode so I'm not quiet sure what's going on there. I spend a lot of time out of work hours with him in an effort to over come this anxiety but even something like walking into the front yard petrifies him. I doubt his spent Christmas with family and the people in the house are not really friends, more room mates. We have limited resources to deal with these kids were I live due to the remoteness of the town and his conditions don't really warrant any specialist care. His just another kid stuck in the healthcare system. They say in nursing you have favourite patients, I guess his my favourite. It's coming into football season soonish, his a keen footballer, his even built like a footballer but his never played a proper game, he can beat me in a backyard game and I've played before. I plan on some how trying to get him to come to football training, he has a natural talent and maybe the encourage meant from other players and the team is just what he needs. We get along well and if I can use our friendship to encourage him to get out and socialise, maybe even get a job then that's better than nothing.

I really have no desire to sleep with anyone I work with... Most of the nurses I work with are my mates mums....

That is such poor care! Wait, did I just say care? Why bother calling the ambulance? Just chuck him in the back of the family car and off we go. Why is ALS not called? Seizures really don't warrant BLS.

I’m 19 and after 3 months of mixed class and practical I get a patient load when I work in the hospital (4 shifts a week). My training requires me to work 40 hours a week in the hospital on 3 month rotations with one 9 hour shift of class per week and 3 week blocks of residential school at certain intervals. I’m also allocated with an RN at the start of each shift but take on my own patient workload but need to be supervised when giving medications or performing an invasive procedure. This is different to being our in an ambulance, fresh out of class and working alone or with a first aid officer on the streets. I’ve always got backup seconds away and work with an RN for most of my shift. In Australia to become an RN or paramedic you are required to under take a 3 year degree, within this course you are provided with a sound theoretical knowledge and spend time on clinical placement working in the real world. Once you’ve done your 3 years and get a job you’re employed as an undergraduate student for one year, in this year you work with/supervised by a senior clinician from either profession and your knowledge is assessed in real situations. By the time your ready to be a sole practitioner your at least 23. You can’t just pass your degree and be sent out willy nilly as the senior practitioner.

BP Checks – RNs go out into the community to places were people gather i.e. Shopping Centre, Local Fetes ect. If they find someone to be hypertensive they get a little slip of paper with a referral to a doctor who will bulk bill to medicare. People are more likely to have the follow up if they know it’s all free. Depending on the age of the patient and how the patient goes with the medication District Nursing and dietitians may be sent in to offer advice on medication management, general health support/monitoring, exercise and diet. It’s not unusual to go out and refer 30 people to the doctor and have to follow up around 5 or 6. Community Health Promotion – Similar to BP checks, they may run an awareness week on prostate cancer, may run a fun run for diabetes, walk a thon for MS, handing out booklets to at risk people for certain illnesses, go into school and talk about safe sex/teen pregnancy, run support groups for Parkinson’s patients, cancer patient, career support groups ect These groups get together and talk about there conditions, the nurses may provide information on new treatments, symptom management, they may even go out and have a coffee. Normally CHP will liaise with Community Interlink who will organize a few hours of respite for cares to come together and have a break. General Health Checks – Again BP, BMI, cholesterol checks. If you’re a smoker they may check your lungs ect. Everyone refers to everyone lol, its not just one service that does everything there all interlinked and there’s great communication between doctors, allied health, other services and nursing. If a certain service doesn’t have funding for a certain thing they’ll refer to someone who knows how to work the government.

I’m doing 3 months of community nursing at the moment. Were based out of a community health centre. I know it doesn’t have anything to with EMS but… Current we have: -Blood Pressure Checks -Diabetes Nurse -Community Interlink -District Nursing -Case Mangers -Mental Health Team -Citizens Advice Buru -Cardiac Rehabilitation -Physiotherapy Services -General Rehabilitation -Community Health Promotion -Podiatry -Foot Clinic -General Health Checks -Dietitian -DOM/Midwifery -Occupational Therapy -Special Projects And so on… I you want any more info on any of these areas let me know.

So, you did your paramedic degree then all of a sudden became the senior practitioner on the ambulance?

Are you the sole provider or under supervision?

We really don’t have many young volunteers in my fire service, about four under the age of 25. All the officers have been in the services for years and have to meet a certain criteria in regards to training and callouts. On some calls the officer will let us be the team leader or incident controller but there always right beside us, ready to take the reins if needed and answer any questions we may have. The sort of calls were they let the newbie’s run the show are calls that have a low risk potential i.e. smoldering log fire, single tree fire in the middle of a dirt paddock ect. We would never be allowed to have any form of leadership role in a house fire, MVA, hazmat, wildfire or anything to extreme, which is fair enough. Were not allowed to drive any appliances under operational conditions until we have our truck license, completed the EVS course and maybe even the 4X4 course. You can’t get your truck license until your 21 anyway. When you turn 19 they will let you drive the support vehicle (holden rodeo) in non operational conditions (fire equipment maintenance, communications training, fundraising, PR ect)

A lot of people in my nursing class have familys, work and study.... I take my hat off.

Indigestion? Im really not sure lol

Is she using lisinopril and norvasc as antihypertentives or is there a previous cardiac history or history of CCF? When was the last time she had hydrocodone? Why is she taking hydrocodone, for pain or in conjunction with trazadone? Apart from shooting up what was she doing upon onset? Sitting in the chair? Running up the stairs? Does the pain increase on inhalation? Pain located anywhere else? Did she get the drugs through the usual dealer, take the same amount as usual? She's double dipping on opioids lol

Hey Foz, welcome mate! How does one become an EMT in Australia? Hope to catch yah around.