Written by Aussie Paramedic Callum Shepherd (currently working in London).
I’ve just finished a night shift and I am writing this off a couple hours of sleep. It was a big night on the road – the first turn of the wheel was to a housefire persons reported. On arrival, smoke and flames were billowing from this house. There must have been about 20 members of the public in the street watching. Some were crying, some taking pictures, some making phone calls, and some filming the fire fighters drag a lady out of the house in cardiac arrest with 30% partial thickness burns.
My crew and I switched into gear and started full advanced cardiac life support and worked on this lady for about an hour. My colleague intubated the patient whilst some other paramedics continued with CPR. I gained intraosseous access, as the probability of securing peripheral access or an external jugular vein was unlikely. Whilst this is ongoing, the fire brigade informs us that there are two people unaccounted for, so we set up two additional roadside resuscitation bays ready for the next two casualties.
We hear the roar of the helicopter fly over our heads and land a few hundred meters down the road – HEMS like to arrive like rock stars. With the assistance of HEMS and the additional crews on scene, we managed to get a ROSC. We are still waiting for the fire fighters to drag out the other two casualties inside the house, then it happens – the fire brigade clears the structure of any further people inside – what a sigh of relief.
The ROSC patient is loaded into the ambulance for a road transfer with HEMS as they are about 8 kilometres from the major trauma centre. All of their bags and kit is onboard, ready to depart…but then I notice the front tyre of the ambulance is flat. “STOP!” I yell. “The tyres flat! We need a new vehicle to transport!”. They all look at me, with daggers. But they understand. We offload the patient and reload them onto a new vehicle.
Finally, the patient is taken to hospital. We pack up the scene and collect all the rubbish, hold a joint debrief between the ambulance, police and fire. My crewmate noticed that the fire fighter who was doing CPR on the patient on arrival was crying. We comforted and talked to him separately and highlighted the exceptional job him and his team did prior to our arrival. We leave the scene back to station so that I can have a shower to get all the soot out of my hair and put on a clean uniform.
About an hour later the wheel gets turned again for patient number two – a person who has jumped off a bridge into a flowing river. The coastguard and water police unit are searching the river for the patient, my team is instructed to split up and cover a number of different jetty’s along the river, so that if the patient is found they can be brought to help and we can initiate treatment as required. We hammer it into town, and all split off, missing a few near accidents on the way in as people don’t understand the “please pull to the left” concept – frustrating to say the least. We maintain communications with the coastguard and police and are continually told to standby. After over an hour of searching for the patient, we are stood down by police and the coast guard, as they are now treating the incident as a body recovery. We pack up for the second time and head back to station.
A few other jobs go by, with a few more cancellations. My dinner was in the microwave at one point and I was ready to tuck into my shepherd’s pie with mash and veg, and then the radio sounds and I’m off again. If you’re still reading, I am about to get to the point – so please bear with me.
The next job we go to is a crew assist for a man in excess of 100kg who has had a status epilepticus seizure that lasted for 20 minutes. The crews on scene struggled to get intravenous access due to the patient’s obesity obscuring venous access points. Rectal diazepam was given and eventually the seizure terminated. The patient was now respiratory depressed with a depressed consciousness that required constant intermittent bag valve mask ventilation. The patient had vomited and there was blood everywhere, due to the cannulation attempts.
I was called to help get this patient down a narrow staircase with an even narrower landing. We put the patient in the MIBS (a type of stretcher/extrication device) and with a team of 6 of us, eventually managed to get this patient down the stairs and into the ambulance. My legs and my back are still hurting. We pre-alert to the nearest hospital and take transport the patient with the lights and sirens going. The patient’s condition begins to improve on the way to hospital, and on arrival at the ambulance bay, he no longer requires supported ventilation and is maintaining his own respiratory function with some supplemental oxygen. We wheel the patient into the resuscitation bays to handover the patient and there she is waiting for our handover – the unimpressed nurse.
For the purpose of this article, lets refer to this ‘lovely’ nurse as Sally. Before I’ve began talking, Sally starts the conversation about my patient. Seems a bit odd doesn’t it? Someone telling you what to do with your patient when they don’t know what’s going on? And then she says those famous nine words:
“You can’t handover until the patient is booked in.”
I’m sorry Sally, but as a paramedic I don’t need to know who this patient is or what their patient ID number is before I begin treating the patient, and neither should you. So, we have started off on the wrong foot to say the least. We book the patient in and start to handover to the team at hospital. Under her breath, Sally decides to impart some wisdom again:
“Why is this patient in resus?”
If Sally wasn’t on her phone during the handover, maybe she would have heard about the treatments given on scene. Now both of my feet are off on the wrong foot and I buckle in, as I’m sure my wrong feet are about to run a marathon. And then Sally goes for the trifecta:
“I’m surprised to see you’re off the couch and actually doing some work this evening.”
Now both my feet are off and wrong, potentially both amputated as the frustration inside me boils. My feet have run the marathon, but then realised I left a defib on scene and have to run back to pick it up and then recomplete the marathon.
I remain calm. As I don’t lose my cool easily. I turn to Sally and I tell her about my night so far – about the housefire and the cardiac arrest, the screaming and crying people in the street, the emotional fireman, the man who jumped off the bridge who we couldn’t recover, the several car accidents that nearly happened tonight whilst we responded to jobs, my food getting spoilt as it sat in the microwave and my sore back from lifting a hefty man down the stairs.
And then Sally’s attitude changes. And she tries to apologise. And at this point I think she realises that she has stuffed up. And at this point, I am not interested in what Sally has to say.
You have made it through the backstory. You’re now probably wondering:
- What’s his point?
- Why did I just read all of that?
- What can I learn from this?
What we know…
- A healthy workplace relationship between paramedics and nurses is fundamental, as the transfer of information from paramedic to nurse contains important information with regards to the patient, they are about to receive
- Paramedics and nurses do not know how difficult each other’s shift has been without communicating
- Paramedics and nurses love and respect each other and couldn’t do each other’s jobs
- Paramedics and nurses are overworked, underpaid and often go without meal breaks
- Paramedics drive fast cars, break road laws and flick on some flashy lights with some accompanying nee-naws
- Sally felt embarrassed
Let’s change our handover style. Traditional handovers are in the form of ATMISTAMBO (Age, Time, Mechanism, Illness/Injury, Signs & Symptoms, Treatments, Allergies, Medications, Background Other) or SBAR (Situation, Background, Assessment, Recommendation). None of us know how each other’s day has been, so let’s all be a bit nicer and empathetic to each other. Add HI to the start:
H – How are you?
I – Identify yourself
- So, why did you bring this patient in?
Let’s stop asking this question. The majority of paramedics prehospitally do not have access to blood tests, imaging and urine dips – there are not many patients who are sent home from hospital safely without a few of these done. If you are really thinking this, then either discharge the patient yourself, or speak to someone who can.
- But they look fine now?
Paramedics can provide lots of treatment prehospitally, and whilst the patient may arrive at the emergency department in a nice little package, this does not indicate the severity of their illness or injury, or what interventions have been given. If you are unsure of someone’s scope of practice, talk to them.
- ‘Ambulance drivers’
Paramedics ARE ambulance drivers, but we also provide high level patient care to a variety of patient types. Ambulance drivers ARE NOT always paramedics, so please refer to us accordingly. We don’t refer to nurses as doctor helpers – and trust me, it is the same type of anger we feel.
Thank you for reading!
I still don’t know what Sally’s day was like prior to my arrival at hospital and I hope she is doing okay. We are all one big family of healthcare workers and emergency service workers who need to look out for each other.
So, if there is one take home message, I hope you have got from this; before we start handovers, can we just ask each other:
“How has your day been?”
(Who is also an ambulance driver)
(Currently in between night shifts)