Palliative Care Paramedics?

I have had death on my mind a lot lately.  In some ways this is not surprising, after all it is an inevitability in the career I have chosen that I will come across death in all it’s guises.  However it is not the pointless deaths in car crashes, motorbike crashes, stabbings and so on that I have been dwelling on, although these play a large part in my everyday life.  Rather it is the is the inevitable deaths, the natural deaths of those at the ends of their lives that I have been dwelling on.  In my opinion paramedics (myself included) do not deal with these situations very well, despite the fact that we are called to them on a daily basis.

SMACC 2014

There has been some chat on Twitter over the last day or so about the involvement of Paramedics in the SMACC Conference.  Specifically about how we can encourage more paramedic involvement.

As you are aware I dragged myself up to Sydney this year for the inaugural SMACC conference with some degree of trepidation.  I was apprehensive that I would be out of my depth; that it would not be relevant to me; that no-one would talk to me; that I would sit in the corner being sad, confused and lonely (basically I was worried it would be like a typical Friday night in town, but during the week)

AmboFOAM hits the Airwaves

PODCAST – Robert Simpson of AMBO FOAM.

My first ever podcast is up over at ruraldoctors.net.  Tim was gracious enough to let me ramble on about a few of the things that interest me, as well as my journey through FOAMed and social media.  Head over, have a listen and let me know what you think.  We hope to be able to get some more content up in the future about various issues, so hopefully it won’t be the last you hear from me.

Calling all Paramedics…

I need some help.  I am looking at creating some content with my mate Tim from ki-docs about starting out as a paramedic.  Not about the clinical stuff but more about the human factors, what to expect, what is important to know; all that sort of stuff.

Sadly it has been a very long time since I started out in the field the world of paramedicine has changed a lot since then.  The things that may have been important to me (even if I could remember them) are perhaps not as important to new paramedics/ambulance officers now.

So with that in mind, I would love to get some feedback.  I would love to hear from all paramedics, volunteers or paramedics to be.  Let me know what is important for a new paramedic to know: how to deal with shiftwork, with people, with partners, with toilet breaks, whatever.  Nothing is off limits, any comments or questions gratefully accepted.  For people training or about to start as paramedics, what is it you would like to ask about the career you are about to embark upon?  I will attempt to answer any questions I can and hunt down the answers to those I can’t.  If you don’t want to put it out there for all the world to see, email me at angryambulancedriver(at)gmail.com and I’ll make sure you keep your anonymity.

The intention is to make a podcast about this and if there are any specific issues that appear to predominate we can perhaps explore those further in the future.

So please, don’t be shy, let me know what you wish someone had told you or what you would like to be told about before you start.

Aggressive Fluid Resus in Blunt Trauma

In the Journal of Trauma and Acute Care Surgery this month two new articles:  Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: An analysis of the Glue Grant database, and Goal Directed resuscitation in the prehospital setting: A propensity adjusted analysis.

(free full texts available)

Most paramedics are no doubt aware of the concept of permissive hypotension in the setting of penetrating trauma to avoid coagulopathy, hypothermia, clot wash out, ARDS, worsened acidosis and so on.  What seems to be becoming increasingly evident is that aggressive use of crystalloids in just about any traumatic setting may be bad for your patient.

Emergency Trauma Management

The FOAMed world provides an ever expanding array of websites, blogs, podcasts, holodeck simulations and vodcasts to take in.  It can be a little overwhelming at times with the volume of information that is out there creating a bit of cognitive overload.

Whilst I love to roam the wilds, there are always a few blogs that I come back to time and time again for their ongoing high quality material (much as I’m sure you, dear reader, do to this one I am sure)

Now I have another to add to the list of mainstays that will blend online FOAMed with real life, in the flesh training.

Sedating the agitated patient

The agitated patient is something paramedics encounter on what often seems like a daily basis in the field.  There are many causes for agitation, but the one we tend to think of, and certainly in my case what our protocols are written to address, is the patient with agitation secondary to psychostimulant drug use, mental health issues, or most commonly, both.  These patients can be extremely difficult to manage, especially with limited resources.  Whilst I believe that the ability to sedate certain patients for their own and our safety is vital, these situations can be fraught with danger.

A brief hiatus and a request.

Some of you may have noticed a deafening silence from me for the last week or so. Never fear, I am still alive and kicking, merely taking a short break. I have a number of things I want to talk about when I get back into it (yes, more on SMACC2013 I’m afraid, but other stuff too)
In the meantime I have request. I recently spoke at a university clinical evening (see my last post). I have noticed a few more hits coming from Australia since then, which I hope is a result of students stopping by.
I would love to have more interaction with students (or anyone else) but I understand that it can sometimes be a bit daunting asking questions or putting yourself out there. So I have included a contact email address (on the ‘contact me’ page) so you can ask questions, make comments or whatever without everyone seeing. Of course you can remain in anonymous when commenting on posts, so please, feel free to get in touch.

Student Paramedics and Subtle ECGs

Last night I was asked to speak at the Australian Catholic University Student Paramedic Society’s clinical night.  Someone I have previously worked with dobbed me in, and I felt I couldn’t say no…

SMACC Breakdown, Part One

As promised I will attempt to share a few things about SMACC 2013 for my loyal reader (thanks mum)

First of all:  Wow.  The entire conference was an absolutely amazing experience.  So much so that I am still suffering from a little bit of cool stuff overload (and a fair bit of fatigue, having got back home around midnight, with an 04:30 start this morning)

So, before I try and sort out all the stuff I got out of it I will get all of my name-dropping out of the way by posting a few pics of the legends I got to see and even talk to.  Exciting!

(Warning, photos ahead, slow connections beware!)