Training vs reality

To demonstrate the utter glamour of my job as a paramedic, I thought I would break from my usual banal witterings and actually do an ambulance related blog.

I won't subject you to this sort of thing very often, as there are lots of perfectly competent and more serious ambulance blogs out there which do the job much betterer than I could, but you'll forgive the occasional lapse, I hope.

As you can imagine, we attend incidents involving explosions and grenade accidents and helicopters crashing into coaches on the motorway on a daily basis, which can get a bit mundane, so I thought I would relate to you a more exotic scenario, and the possible differences between our training and reality.

Training
Approach scene with care, being aware of dangers both to yourself, your crewmate and the patient.
Reality
Look around for crewmate. On own. Again.
*Door bell*
No answer
*Knock*
No answer
*Heavier knock and doorbell*
No answer.
*Psychotic knock usually heard just prior to someone using axe and poking head through resulting hole in a 'Here's Johnny!' stylee*
No answer.
Check door.
Door open.
Loud telly noises coming from within.
"Hello?"
No answer.
"Hello, ambulance!"
No answer.
"AMBULANCE!"
No answer.
Walk through hallway and into lounge.
Old couple sitting in comfy chairs, watching the One Show with volume turned up to eleven.
"Hello?"
Watch both people jump with fright. Note that the frail looking man clutches chest and goes a bit blue. Make mental note of chest clutching blueness.

Training
Wear appropriate personal protective equipment, including latex gloves.
Reality
Know that old ladies view rubber gloves with the utmost suspicion, and will presume you are wearing them solely to avoid leaving finger prints whilst you steal their Jack Russel and molest their china, so keep them in pocket until really needed, which probably won't be long.

Training
Call for help.
Reality
I am the help.

Training
Assess airway.
Reality
Patients are smoking, so airway's probably patent.

Training
Assess circulation
Reality
Man is blue but waving fag lighter at you, so probably has got a pulse.

Training
Introduce yourself
Reality
Shout "Ambulance!" into his ear five times, point at your badge, then your bag, then the ambulance parked outside his window, point at the telly, ask if you can turn it off as you're turning it off, shout "Ambulance!" again, man points at his ears, eventually go to his bedroom, get his hearing aid off bedside table, blow dust off it, put it in enormous ear, take it out, change the battery, put it back in again, wait for the high pitched scream that tells you it's working, then shout "Hello!". Man says hello back loudly, puts his thumbs up, then asks who you are.

Training
Identify and assess patient as you approach, such as colour, position, and signs of distress.
Reality
Note with quiet alarm at just how ill the man looks. Man coughs from effort of talking to you, goes blue and clutches his chest again.
Then he smiles and says "It's my wife."

Training
Get appropriate patient observations, such as pulse, blood pressure, oxygen saturation levels, ECG etc.
Reality
Look at lady, who looks a lot weller than her husband. Double check that she is definitely the patient. Ask her what the problem is, to which she nods enthusiastically and says "They don't know a good mushroom when they see one, you know!"

Training
Establish medical history of presenting complaint.
Reality
Ask husband what the matter is? Husband shouts that she's gone "all funny" on him.

Training
Identify problem
Reality
Sniff patient. Ask if she's had a wee today. Note that she screws her face up in distaste at the memory of it. Problem identified. Decide to confirm urinary tract infection with urinalysis dipstick.
"Could you do a wee, Muriel?"
"In the war, yes!"
"No, a wee? Could you spend a penny for me? So I can get a sample?"
"Did they!?"
"No, a wee!?"
"Did we?"
"No, A WEE!"
Do mime. Regret doing mime. Look at husband, who is trying not to laugh. Ask husband to help, as maybe exotic accent isn't getting through.
Husband takes sample pot and waves it at his wife.
"PISS!" he shouts at her

She nods, takes the pot and wanders off, coming back with sample and wet hand.

Training
Identify appropriate care pathway for patient
Reality
Home

Training
Give patient appropriate treatment.
Reality
Get antibiotics and go through their use eleven times with both people. Write it down on a sheet of paper and give it the lady, who folds it into a stamp sized cube and puts it in her purse.

Training
Ensure family has appropriate care level in place.
Reality
Ask husband if he's feeling all right. Nod sagely as he proudly tells you he's never had a day sick in his life, and never been to see his GP, despite smoking forty a day for half a century. Help him back into chair after coughing fit dislodges him. Wait for him to go from bluey-grey to pink again and take opportunity of holding his arm to surreptitiously take his pulse.

Pulse goes "Di-di-di-dit dit de-dah di-dah-dit dah di-dah dah dah di-dah dah-di-dah-dit dah-di-dah"

Make concerned face as this spells out HEART ATTACK in Morse code, a late sign of myocardial infarction

Ask if patient has got any chest pain and if so, for how long? Patient answers "Yes, since 1982."

Ask if patient would like an ECG, as I've got it here anyway? Patient asks how much it costs, and agrees when he finds out it's free.

Take eleven layers of clothes off patient. It is July. Patient is hairier than a gibbon in a sweater. Use NHS issue razorless razor to flatten down a couple of the hairs prior to attachment of electrodes.

Print off ECG. Computer informs you that noisy Data means it can't identify the rhythm for you so you've got to do it yourself. Sigh. Read strip. Read strip again. Sigh again.

Put on encouraging smile and get down to eye level with patient before gently informing him he might be having a heart attack and that we should go to hospital immediately to reduce the risks of, you know, dying and that.

Begin calling for back up on radio.

"No ta." says the man, counting his cigarettes.

"Er . . . remember the heart attack thing we talked about."

"Yep." says the man, who then says that, if he's going to go, then this seems like a better way than many, in his own house, and that you're not to tell his wife.

Training
None
Reality
Eventually leave patient in house, having signed a disclaimer and grudgingly accepted the possibility of a doctor's visit at home with an eye on persuading him to go to hospital. Chap waves a cheery goodbye from the door, unlit fag in hand, blue lips smiling contentedly and probably not thinking of quitting smoking.

Return to station.

Training
Reflect on issue, write down reflection and include it in Portfolio of Continuing Professional Development, perhaps with some references on patient autonomy and the cornerstones of medical ethics.
Reality
Have a cup of tea.
Discuss with colleagues, who offer helpful advice like "Ooh, fancy that!" and "Bourbon cream?".

Get call out for elderly lady who has fallen on the floor and is having troubles getting up again.


There you go. Like something out of casualty, innit?