Wednesday, 17 October 2012

Friday, 24 February 2012

90 Enquete, SAMU l'urgence au quotidien

French Prehospital care which is provided for by SAMU and Pompiers. Physician led system.
Unfortunately I'm limited to "Je suis mal al a tete" or jai mal au dos!" Nevertheless there are several of these shows available to watch. Even though it's in French (obviously)it's pretty easy getting the jist of things (if you have EMS/prehospital background). Well I enjoyed it anyway.

Tuesday, 21 February 2012

Me and the misses (no kids, yayeeee!) are off to New York City in a few weeks time so if any guys on an EMS bus want to let me get a pic that would be great.

South African EMS

Wednesday, 4 August 2010

Bright lights and shiny steel

I get a call, Cat C, the lowest priority call. Female unwell. I'm working on a response car and arrive within a few minutes. The door is open and I'm faced with an elderly lady sat in her arm chair complaining of abdominal pain. As I get closer I notice the beads of sweat running down her face and chest. This lady isn't well at all. There is no back up available, I'm on my own. A quick examination reveals no radial pulses, indicating that her blood pressure is very low. She has abdominal pain radiating through to her lower back. I don't need a medical degree to work out what's going on. This lady has a leaking AAA (abdominal aortic aneurysm) and the clock is ticking. I call for a crew and start my other observations, ECG, blood pressure and oxygen saturations. She has an enormous vein on the back of her hand which is a dream come true in a seriously unwell person. I place a 14g IV with ease. The crew arrive and another BP is obtained, it's 70 systolic. 500ml of Hartmans is run through by the time we get to the Resus room, pressure now 99 systolic and before we know it the consultant is performing an ultrasound scan. Diagnosis confirmed, leaking AAA.
The last place this patient needs to be is A/E or in the back of an ambulance, she needs to be in the operating theatre or as one of my old training officers likes to put it "She needs to be where the bright lights and shiny steel are".
When I last checked she had gone to the operating theatre (OR for my US colleagues). I don't know the outcome. I hope she made it.
The job came in as a Cat C call, it turned out to be a genuine Cat A. If a Cat A breathing difficulty came in I would have been redirected to that and chances are it would be a 15 year old hyperventilating having a panic attack. My Cat C lady may not have made it.

Chronicles of EMS

I'm back! Don't know how often I'll post or what about. Many seem to have fallen by the way side. Shame really. Just been watching chronicles of EMS with Mark G (aka medic999) and it reminded me of when I was in Richmond VA. Wish I'd had a camera and filmed it know. Doh!
Anyway I've added the link (look left), Enjoy.

Saturday, 19 September 2009

What a beauty

Nothing ambulance/EMS related but I've just been watching this fly. Such a beautiful aircraft.

Friday, 11 September 2009

Saturday, 5 September 2009

Running on empty

Sat at the hospital waiting to push clear. We pause as we hear the crew, that had previously cleared, get a job. It was to a person in a car on the side of the road and they were having real difficulty locating the person. Oh well, so we pressed clear. Next thing we get a job and it's also to a person in a car on the side of the road. Psychiatric problems. I was wondering why we copped the same job seeing as the other crew were closer. As we are so often reminded by control "You don't know the bigger picture", I wasn't going to argue. Even if we really wanted to get back to base for a cuppa. Details were sketchy and the location was somewhere along a road that stretches pretty much from one end of the county to the other. It was passed as a Cat C, non-life threatening. We heard some radio traffic and it appeared that the other crew were still attending, not because it was serious but because there was two separate incidents. Two cars, both psychiatric patients, both wanting our help and both crews non the wiser of the exact location of either. We eventually got a description of the car and went to search in the west. The other crew were searching the east. As soon as we were on the dual carriageway we spotted a car in a lay-by on the opposite side of the road and people were waving. Because of the central reservation we had to drive 9 miles to the next slip road and back again to get to our patient. Police were also thundering up and down the road. "They must know something we don't" I thought. We arrived and pulled up in front of the car. As I got out I could see someone lying in the front passenger seat and as we drew closer he appeared to be dead! His colour was appalling, white and grey with blood and faeces mixed in for good measure. Not quite what we were expecting at all. I took a closer look and spotted a deep laceration to one of his wrists. It had stopped bleeding. He was incoherent and moving around without any real purpose. I tried to put an oxygen mask on him but he kept tearing it off. A severe lack of oxygen in the system will do that. While he was waving his arms about I spotted another deep laceration this time it was at the crook of his elbow on the same arm as his wrist laceration. He had done this to himself and had done a good job too. I glanced behind him and in the rear on the floor was a mass of congealed blood. He must have lost half his blood volume. I was surprised he was still alive! As my crew mate was bringing the trolley over I decided to get some IV access in the chaps arm as everything else was proving fruitless. A couple of police officers helped stabilise his arm while I inserted a 16g (grey) cannula. I stuck it down and then secured it with a bandage so he couldn't rip it out. I didn't attach any IV fluids at that point because I knew that the IV would be pulled out for sure. We managed to get him out of the car and onto the trolley and then into the vehicle. I got the fluids running (as there was no radial pulse) while my crew mate desperately tried to obtain a blood pressure. Unrecordable. I needed another line. The only other real option was one in the leg. I could have gone IO but spotted a vein on the inside of his ankle. And in went another 16g and another bag of fluid. No time for blood samples, the hospital could get them via the femoral route later. All while we were working on this guy I spotted a German couple in a motor home filming us, cheeky buggers! We weren't there long and were soon off to hospital. His blood pressure was now 82/36 after a 800ml of fluid and there was a weak radial pulse present. He had also settled and was now tolerating the O2 mask but was still incoherent. This guy needed blood and not basically water in a bag.
I think he had cut himself sometime earlier as his blood vessels had clamped shut and were no longer bleeding (the critical hemorrhage kit was not needed). A few minutes later we arrived at hospital and went straight into resus. The young DR seemed impressed that I managed to get a 16g IV in his arm especially after all the blood loss but when I lifted up the blanket and showed her the 16g in his ankle, TA DAAA!!!, she grinned "Blimey, we had a bet when we got the pre alert and it said Paramedics have an IV, we all said it will only be a green (18g). And you've got 2 greys in! Well done!" (I'm so glad I work where I work. The hospital staff are great and we are like one big family)
Anyway we clear up the truck and off we go on to the next job. Later we see the guy who is now a nice pink colour and reasonably coherent, enough to have a simple conversation with. He received 6 units of blood and was due to go to theatre to have his tendons, nerves and blood vessels repaired.
Why he harmed himself, lord only knows. A good job though!