Own the OG

I am not by nature a boastful person.  In fact, I have issues with self confidence.  Many might find this hard to believe, but that is only because I work hard to present a calm, confident exterior, as I think it benefits everyone at a job if I keep my inner turmoil to myself.

However, one thing I reckon I do ok at is the technical side of being a paramedic.  The old cry of “they can never get a drip in me” is merely a challenge, and I have never met an airway I can’t secure somehow.

But we all have a nemesis, and mine is the gastric tube.  I can happily jab the wriggliest of veins through the adiposist of tissues (pretty sure that’s a word), slot an ETT in the grade 4ist of airways, and then come horribly unstuck trying to pass an OG tube.  Nope.  Cannot do it.  Not happening.  Fuck it, you do it while I cry in the corner.

I keep my OG tubes in the fridge to keep them stiff and help me get  them in, but even the stiffest of tubes still will not go where I want it (oo ‘er!)  Now, however, I have a new trick that I can’t wait to try, thanks to some of the smartest and nicest blokes in #FOAMed, the ScanCrit crew.  Check out Daniel’s post “Own the O.G.” over at ScanCrit.  I don’t want someone to need an OG, but by  god I want to be there when they do so I can try this!

Posted in Airway | 1 Comment

A great day for Australian Paramedics…

Today is a great day in the history of paramedicine in Australia.  At long last the heads of government in Australia have all finally supported paramedic registration (thanks NSW…)

This is a momentous occasion and a fantastic step forward for the profession of prehospital care.  We all will benefit from this, but none more so than our patients.

To all who have worked towards this and given your time selflessly, my thanks and congratulations.  You are all a credit to our profession and to your selves.  Thank you.

Paramedics Australasia Facebook

Hon. Jill Hennesy twitter

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Robbie Rants: HEMS Requests

A short podcast, thanks to the PAIC2015 FOAMed attendees.  I hope you’re happy with what you’ve started!

Click to play

Click to download

HEMS Request


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Can I get HEMS?

I’m back up in Ballarat at the moment, working in the control room, and one of the most common question I get is “can we have HEMS?”.  The answer is often, but not always “yes”, however there are a number of things that need to be considered before a helicopter is launched.  We will take a brief look at air operations in the post, however please bear in mind that this is from the point of view of me, a clinician.  I am not a HEMS medic, I am not a Flight Coordinator, so everything I write here must be treated as suspect.  Much like all my other posts…

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PAIC #FOAMed Workshop Introduction.

Hi everyone.

Unfortunately I am unable to make it to the Paramedics Australasia conference in Adelaide this year.  I was looking forward to taking part in the FOAMed workshops, however other events require my attendance, so I won’t be there.

But fear not!  You don’t have to miss out on me making noises with my face at you; thanks to the wonders of modern technology, I am able to transcend time and space and talk to you all in person!  Sort of.

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Another SMACC Perspective

This week (somewhat late) we have another perspective on SMACC from Ben Lawson (@Paramedidad).  Ben is a Paramedic from Queensland and a first time SMACC attendee.  Please note the lateness of this post is entirely my fault: Ben emailed me before even getting home from SMACC.  Sorry Ben!

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Posted in Education, SMACC, Social Media | 2 Comments

SMACCed Over

SMACC has come and gone again for another year.  It’s always a bit of a comedown, returning to normality after the conference, and this year it is with greater sadness that we return to our ordinary lives.

Enough has been written, tweeted, and blogged about the death of Dr John Hinds just after the SMACC conference.  Nothing I can say will add to that, or make anyone feel any better, so rather than dwell on the loss and sadness, I will instead look back at the fun times I had at SMACC this year.

Please be warned, this is essentially the online version of my holiday photo slideshow.  It is image intensive, and catastrophically boring for everyone but me.  I shall therefore take delight in inflicting it on all of you…

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Around the middle of 2004 I found myself sitting at a desk in a huge hall with about five hundred other people. They fidgeted and sweated and nervously chatted amongst themselves. I tried not to get sucked in, but I was nervous too. You see, it was the first of several rounds of testing that I had to undergo to be employed as a paramedic.

The three-part exam was unsurprising. There was a maths component, an English-language literacy component, and a short essay. I was told that the essay was designed to test my ability write coherently, but the topic suggested that there was more to it: “Why do you want to be a paramedic?”

Why indeed?

I knew what I was meant to say – I was meant to bang on about how I wanted to help people or something to that effect, and so away I went. I wrote three pages on healing the sick, comforting the wounded, and generally being Nightingale-esque. It was a little cynical, but it got me the job.

Recently I brought this event up in conversation with a very senior and experienced paramedic. He told me that when he started it was completely normal and routine that people would apply to work for the ambulance service chiefly because they wanted to serve their community. He told me that the idea of service was people’s key motivation when he started, and that idea was reflected in my exam paper.

The idea of community service as a main motivation seems quite exotic now, and my colleague’s concern was that junior paramedics are now far more ego-focussed and selfish than they used to be. I can’t comment on that directly, but he also made the point that mainstream values have sharply shifted away from communitarianism towards individualism over the course of his career, and that it makes sense that junior paramedics internalise those values.

That may or may not be true (I suspect that it is), but I want to make the point that even though it’s unfashionable, service to one’s community is absolutely critical to your career as a paramedic. It is what will keep you functioning when you’re in hour 13 of your shift and are desperate for sleep. It will keep you turning up, week after week when you’re not feeling it. It will keep you from dreading Mondays. Service and duty will allow you to function in a difficult job, even when things aren’t going your way.

Service is not only at the core of what we do, it’s at the core of how we keep ourselves sane. Our work has intrinsic value independent of the money we are paid or the prestige we believe ourselves to have. Without a feeling that you’re helping your patients, you might as well be working a customer service job – the hours are better, after all. The worst times of my career have been when I have lost sight of the idea of patient care and have felt myself to be an ambulance robot, going through the motions. I became unmoored from the purpose of my work, and had to try to find it again.

Service is hard. No-one is denying that. You will have to make decisions about how to spend your limited time and emotional resources. But, for better or for worse, a feeling of service to the community and a focus on patient care is what will buy you longevity and happiness as a paramedic.

This may seem like harnessing a communitarian value for your own individual psychological benefit and that this might be somehow dishonourable or dishonest. But isn’t that the core of all community work? Regardless of motivation, both the individual and the community benefit. Think about the unhappiest people you know; I would lay money on the idea that they are also the people who have the least engagement with the people around them.

Did I believe all that when I wrote that exam paper? Not really – I was mainly motivated to gain employment in a job that excited me. But after I sat that exam I went home and had a big think about why I wanted to do the job. I hadn’t felt that I’d told an untruth but I felt I needed to refine my ideas more. When the time came for me to be interviewed for the job, I was asked the same question.

My reply was this: “I want to be a paramedic because I want to work in a job where even if I only treat one patient, I am able to go home at the end of the day feeling that I left the world better than I found it”. Then and now, it remains the truth, and I hope that if that ever changes I’ll find something else to do with my time.

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Paramedic Burnout.

There is a growing awareness that working in healthcare is hard not just on the body, but on the mind as well.  However there is relatively little published research into the effects of burnout on Paramedics.

Dr Liz Thyer (@lizthyer) from the University of Western Sydney is trying to change that, and you can help.  Click the link to head over to SurveyMonkey and take a brief survey to help determine the prevalence of burnout amongst paramedics in Australia.  If you are an Australian paramedic, 15 minutes helping Liz help you will be time very well spent.

Posted in Mental Health | Tagged , | 1 Comment

Let’s be clear! Not all trauma patients must be treated with spinal immobilization during prehospital resuscitation and transport.

Originally posted on MEDEST:

ems-backboardsSpinal immobilization is performed in all trauma patients from the rescuers in EMS systems all over the world, regardless the mechanism of injury and the clinical signs.
This kind of approach is nowadays been rebutted from the recents evidences and the actual guidelines.
ACEP, in Jan 2015, released a policy statement entitled :”EMS Management of Patients with Potential Spinal Injury” clarifying the right indications, and contraindications, for spinal immobilization in prehospital setting.
The lack of evidence of beneficial use of devices such as spinal backboards, cervical collars etc… is in contrast with the demonstrated detrimental effects of such instruments: airway compromise, respiratory impairment, aspiration, tissue ischemia,increased intracranial pressure, and pain, consequent to spinal immobilization tools, can result in increased use of diagnostic imaging and mortality.

Already in 2009 a Cochrane review demonstrated the lack of evidences on use of spinal restriction strategies in trauma.

Recently the out of hospital validation…

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