There are many reasons to call an ambulance, but today I’m going to discuss some reasons that are not valid. Indeed they are not reasons to call an ambulance. For each one there will be, as with any rule of thumb, exceptions, but rest assured that these exceptions are exactly that – exceptions to a rule which is otherwise to be considered irrefutably true and valid.
- Because you’re having a baby: With this example I am talking about the full-term pregnancy with no complications. Premature or expected difficult deliveries, by all means give us a call. But for the full termers, think about it. You got pregnant, and have had somewhere in the region of nine months to plan your trip to the hospital. Sure you didn’t know exactly which day it was going to crop up, but surely you could have a partner/friend/family member on standby for the last couple of weeks of your gestation who is within driving distance of you, to pop you in the car.
- Anything that starts with “Well it all started 3 weeks ago…”: The exception here is if the thing that started 3 weeks ago has changed significantly for the worse. Otherwise if this story involves you having had an ache/pain/dizziness/nausea/insomnia/bowel trouble etc, etc for 3 weeks, and you have done nothing about it, until tonight when you have decided at 0430hrs that an ambulance should pop along and provide you with a panacea for all your troubles, think again…
- Because you can’t see your GP: By this I don’t mean you can’t see a GP, but I’m talking to that cohort of patients who give it a bit of “But I’ve seen Dr. Zhivago for 30 years, and he’s the only one who ever knows what’s wrong with me…” That’s not true, so harden up and see a different GP.
- Because you think you’ll get seen quicker at hospital if you travel by ambulance: You won’t, and if you insist on coming with us there’s a fair chance I will influence the triage nurse to make sure it happens that way.
- For anything south of the border: I’m good with things wrong with your heart, your brain, your breathing or broken bits. If it’s downstairs in what is technically known as the “Swimsuit Region”, I am not interested. If it’s an emergency I will drive you to hospital, but I don’t want to see it.
- Because your baby did something: I know babies don’t come with a manual, and I know you might be sleep deprived and stressed at the thought that this tiny life is now your responsibility, but seriously, the first time junior sneezes/farts/vomits is not an emergency – babies do that. Get used to it.
- Because you think there is a law-suit pending: This one is aimed fairly and squarely at public businesses like supermarkets, cinemas, shopping centres, etc. If a patron of your establishment is injured through some incident for which you might be liable, but it is not an emergency, then my give-a-f*ck-ometer will not register a reading if you call me. I will not write any paperwork for you, and I will not provide you with any details so that you can subsequently call me as a witness in court.
- Because you saw it on “A Current Affair” or “Today Tonight”: These titans of journalistic integrity provide about as much useful health information as your average turnip. They have a history of promoting dodgy diets, magnet therapy, hologram power bracelets, quack cancer cures, etc, etc. The sad thing is that they could actually be using their power for good instead of evil, but apparently there aren’t enough ratings in good advice. Still, if you have called an ambulance based on something you saw on ACA or TT, you will make it onto my shit-list.
- If you won’t disclose what is actually wrong: Believe it or not, this happens from time to time. There is always a risk that you may indeed have a serious problem, so I need to know for professional reasons in case I need to treat you or alert the hospital to any significant issues. Of course the other issue is this – it will inevitably be an embarrassing or sordid tale, and this means that I want to know what you have inserted where before I take you to hospital.
Like the man who called us because he had a huge gash across his buttock where he had slipped while sitting on the wine bottle. It took a few minutes to work out that the neck of it was still up there. Or the girl who called us with abdominal pain, but more sort of lower down and round the back. And her sheepish and anxious boyfriend sat quietly cowering in the corner, and finally left because she decided to fess up that she’d let him pop it in her wrong ‘un, but it was too big. Or the man who called us after his wife had fisted him up the pooper (I couldn’t resist glancing across to see how big her hands were). I guess that if there is a moral to this tale it seems to be that the bottom is an out-hole. But suffice to say, if you call us you need to accept us into your circle of trust, and be in a sharing place.
Of course all of the above reasons are null and void if your name is Jennifer Hawkins or Megan Gale. In which case call anytime. Even if it’s just for a chat.
A friend of mine called Maria asked me for some dating advice – I’m not sure why, coz it’s a long time since I’ve dated, and when I did it wasn’t with boys - but for the record here are 20 bits of advice, given in response to questions I thought she might at some point ask:
1) It depends – if he serenaded you with “Maria” from West Side Story it’s corny, but classic. If he serenaded you with “Maria” by Green Day or Rage Against the Machine, it’s odd but funky and alternative. If he serenaded you with “Maria” by Ricky Martin, then I’m sorry but “Houston, we have a problem” coz that boy is headed for the pink side of the moon.
2) It’s roughly the same length as the distance from the base of the thumb to the tip of the middle finger, and about twice as thick
3) Check to see how well he can use his computer mouse left-handed first – it’s much more reliable than looking at his internet history
4) If he went to an all-boys school, or was an altar-boy at church, then he’s definitely tried it at some point
5) That depends – waxing is OK, shaving not so good, and if he shaves it into his initials then it’s a definite no from me
6) I wouldn’t let him put it up there unless it’s a special occasion, but watch out for the old “It just happens to be my birthday” line – check his drivers licence first
7) I always think that there’s only two things you can never have too much of - romance, and lubricant
8) I would go with the Naughty Nurse, Sexy Schoolteacher or Dirty Nun. I would explore other options, but definitely draw the line at Julia Gillard.
9) No, it is not good for your skin
10)There are no recorded cases in the medical literature of them turning blue – it’s a figure of speech – but they may ache a bit, in which case tell him to go home and practice his left-handed mouse-work and he’ll be fine
11)If you’re going to let him do that make sure you have a safety word, or failing that a safety grip on his balls, so he stops when you say so
12)Consider it like toothpaste. It’s not dangerous if it gets in your eye, but it might sting a bit, so rinse it out straight away
13)I would hold it for him, but I wouldn’t let him jiggle it around
14)You could try, but I don’t know that it is technically possible to get them moving in different directions at the same time
15)I don’t think the issue is so much whether he owns it. Even if it is his, I don’t think it’s legal to involve the dog unless you’re in Tasmania
16)Drinking a lot of water will reduce the odour, but it will also dilute the colour, so if he really wants the “Golden” bit of it you may have to put up with the stink
17)You probably need to clarify whether he was asking you to get him a teabag, or give him a teabag – it’s the difference between whether what you did was a surprise or a disappointment
18)I would probably tell him to do it himself, while I watched. But don’t watch from too close – you might end up with an arsehole in your face
19)That depends, if he wants to lie in bed afterwards and make baby-talk that’s one thing, if he asks you to change his nappy that’s a whole other world of weird
20)No, the correct ranking (from best to worst) is Dusty Sanchez, Slightly-Muddy Sanchez, Dirty Sanchez and Absolutely Filthy Sanchez. It’s to do with how far he inserts it, and what you’ve had to eat the day before.
Not The Big Needle – AKA - Not Much Help When it Comes to Dating Advice
The following story is not news:
http://news.ninemsn.com.au/national/8096915/ambos-forced-to-deal-with-absurd-calls
This problem has been going on since Noah got out of the boat-building business, so why does it get a headline?
Because Ambulance Service of NSW has started a media campaign to try and stop nonsense calls. Yay for them! And what facts do they present to make their case? And I quote…
“It doesn’t have any firm figures because of the way calls are recorded, but anecdotal evidence from triple zero operators indicates the problem is getting worse.”
Now just to be clear, there is an old scientific saying that goes a little like this:
“Anecdotal data is no data at all. And many anecdotes are many times nothing.”
So we have a government funded, public health institution, starting a campaign based on no evidence (but funded with public dollars), claiming they are addressing a problem that may or may not exist…
So are they addressing a problem?
Well London Ambulance Service ran a very impressive Christmas campaign (on the back of a prior billboard “Ambulance vs Taxi campaign”) that went a little something like this:
http://www.youtube.com/londonambulance
And the result was? Well there is no evidence that it worked. And you can guarantee they would have published it, if it were positive.
So why has NSW decided to follow suit, and not only follow suit but to go public with it?
Well a cynical person would suggest that this is a public education campaign based on looks rather than evidence…
Sure it makes sense that if you tell people not to call an ambulance unless they really need it that maybe they won’t, but is it worth spending the public dollar on? Unfortunately the answer is no – there is no evidence that it works.
This is due to the fact that people call an ambulance because they are in a crisis situation, and to each individual a crisis is different. So it becomes incumbent on the Ambulance Service to deal with the calls in a manner that means they get an appropriate response. But unfortunately that message was lost last Saturday in Victoria:
http://www.abc.net.au/news/stories/2010/09/27/3022807.htm?site=melbourne
So why are NSW spending money on an education campaign that probably won’t work?
Well again a cynical person may be pushed to mention that the people calling for an ambulance are from older, lower socio-economic demographics, and that these adverts could be pointless; and they may provide evidence for that theory, such as:
http://www.annemergmed.com/article/S0196-0644(97)70221-X/abstract
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123835/?tool=pubmed
Against that argument may be the evidence to the contrary such as:
http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2005.11.079/pdf
Which is evidence that fails to address the point that ambulance paramedics are unable to rule out a large number of possible ailments, and hence it is incumbent on them to transport a large degree of patients.
So we go back to NSW spending taxpayer’s money on an education campaign that is based on no evidence, and fails to address the real reason why people may be calling an ambulance, and can provide no reason why it might work.
Well done NSW…
More about vaccination soon, but here’s a quickie…
So what exactly is the state of the Victorian emergency health system currently? Well the easiest way to explain is with an example:
In Victoria, Emergency Departments are supposed to follow the Australasian Triage Scale. An education pack on this topic was released by the Victorian Government, and can be found here: http://www.health.vic.gov.au/emergency/bgdocs/edupack.pdf
Basically this scale outlines for the nurse at the front of the ED (the triage nurse) how soon patients should be seen by a doctor. The nurse allocates each patient a category, and the categories go like this:
Cat 1 – Seen immediately, life threatening emergency
Cat 2 – Can wait 10 mins, but are critically unwell
Cat 3 – Can wait 30 mins, but have an acute, severe illness
Cat 4 – Can wait 60 mins, have an illness that is semi-urgent
Cat 5 – Can wait 120 mins, are a malingering f*ckstick that can’t be bothered seeing their GP (definitions as per the Federal Government at http://www.health.gov.au/internet/main/publishing.nsf/Content/health-ahca-sooph-outs_emergency.htm, except for Cat 5, but that’s what they wish they could say).
So when I was one of 3 ambulance with Cat 2 patients waiting at a major metropolitan Melbourne hospital (which was not on bypass) for over an hour a few days ago, one begins to wonder about the health of the system.
Waiting in corridors is not good for anybody – it’s not good for patients, because nothing is happening, it’s not good for the hospital because we are in their way, and it’s definitely not good for ambos, because our minds start to wander. And idle hands are the devil’s playthings…
After we had been waiting in the corridor for a while our patient drifted off to sleep thanks to some generous pain relief administration via the Big Needle, and my partner went and got a newspaper to read. He returned, purloined a chair and sat behind our patient to read it. Halfway through his paper, for my amusement he enacted the following monologue:
(An imaginary hospital worker comes up, looks at our patient, and informs us that they are no longer breathing…)
{The newspaper gets lowered just enough to peek over it}
“What? Not breathing? Aaawww, f*ck it!”
{Turning to me}
“You know what this means. That’s going to drop us to a Cat 6 and we’ll be here for f*cking hours now!”
{Turning back to imaginary hospital worker}
“You couldn’t do us a favour could you? Just pull the sheet up over their face, and then go and let them know at the front desk?”
{Newspaper gets raised again with nonchalance}
The humour in this little scene obviously comes from the complete disregard for patient welfare that my partner displayed. Unfortunately this is exactly the disregard that the government is currently showing for the Victorian public on a daily basis, as they watch Ambulance Victoria and the Hospitals struggle to cope with the workload, and leave them understaffed and under-resourced. A sour note to end on, I know, but the truth can be bitter…
If you take a look at the history of mankind, medicine will surely pop up as one of the great achievements. And in the history of medicine there are many individual achievements that could qualify for any list of the “Top 5” of all time; hand washing, germ theory, transplantation, antibiotics and evidence-based medicine to name just a few. If any of these are unfamiliar please google them, as they will clearly be part of your, or your loved ones, lives (if not entirely responsible for your current existence). The names of people like Semmelweis, Koch, Pasteur, Florey, Carrel, Medawar and Cochrane do not deserve to drift into insignificance – especially at the expense of people like Hilton, Lohan, Pitt and Jolie.
Today we’re going to look at one of the baffling controversies of our time, which is vaccination. The Big Needle must be honest here – I didn’t think this would be a question in the 21st century, but it appears some people still have cause to question the value of vaccination, so in the interest of public health education the Big Needle is going to make a statement.
And that statement is this: Vaccination is a good thing, f*ckn*ts.
Now just to be clear, the noun “f*ckn*ts” is used to denominate anyone who claims vaccination is not a good thing, or in particular the Australian Vaccination Network (AVN).
Now the AVN have for a long time been unequivocally anti vaccination – despite their bizarre claim that they are somehow neutral to the issue – and amongst many anti-vaccination propaganda documents they distribute is a document titled “10 reasons why parents question vaccination”. This document summarizes some of the common arguments against vaccination (1):
http://www.avn.org.au/index.php?option=com_content&view=category&layout=blog&id=75&Itemid=216
This is one of many documents that led the New South Wales Health Care Commissioner to declare in a public warning that they are “solely anti-vaccination” (2):
So the Big Needle decided to step up and address some of the bullshit with facts.
I will tackle piece by piece the top ten reasons the AVN decides to object to vaccination, and let me be clear about why:
The information I provide is clearly referenced and review-able so that you (the reader) can make an educated decision regarding vaccination. In the event that you know someone who is actively anti-vaccination, I welcome their reference to this information, and if they are willing to entertain discourse I will happily be their foil in an educated debate regarding the virtues of modern medicine.
But onto the AVN top ten, addressed one by one, as they have written it:
1) Vaccines have never been tested
This is bullshit of the first water. In reality vaccines are tested prior to release, as are any other proper medications:
http://www.cdc.gov/vaccines/resdev/test-approve.htm,
http://www.cancercouncil.com.au/editorial.asp?pageid=253
http://www.australianprescriber.com/magazine/26/6/144/6/,
Challenge this argument and the semantic argument the AVN (as do many anti-vaccination people) tends to fall back on is that vaccination has never been subjected to testing by double-blind, placebo controlled trials. This is the kind of claim that assumes that double blind, placebo controlled is the only scientific trial that can be performed to establish the usefulness of a medication. If this were the case then the question should be raised as to why the AVN supports the idea of homeopathy, chiropractic, or other untested treatment modalities that have failed to demonstrate any benefit when subjected to such a standard, but I digress…
When looking at double-blind, placebo controlled trials one has to examine the ethics of running such a trial (which is why any institution overseeing research has an ethics committee). If the proposal were made to conduct a trial consisting of taking 100 babies, vaccinating 50 and not vaccinating the other 50, then watching to see how many in each group caught diseases that are preventable by vaccination, I can imagine an ethics committee having a problem with that. So it wouldn’t get approved, and quite rightly too. The standard for medical research has for decades been that a trial should not be conducted that puts a group at known risk of harm (for the history of this branch of medical ethics see Ref 3).
And vaccination is not the only medical treatment that is in this basket. Indeed every cardiac arrest patient gets given adrenaline (and usually by the bucketful), which has never been subjected to double blind, placebo controlled trials in this context. It is merely convention, and based on scientific knowledge of how it works, that leads to its continued use. Never mind that (based on Victorian stats) around 70% of patients given adrenaline during cardiac arrest die (29.4% survival to discharge from hospital in the first 3 months of 2010 according to internal reports). An “untested” drug is given to people with claims it will help them, but 7 out of 10 patients die! Why aren’t the AVN up in arms about that..?
2) Vaccines contain toxic additives and heavy metals
They certainly do. But making this claim in isolation is like saying breathing will kill you. It will, if you try and do it underwater, and there are any number of drowning victims to prove it, but it’s all about context. So what is in vaccines? Well this question was answered by a comprehensive study done in 2006 by Eldred et al, and published in the Medical Journal of Australia (4). In short, there are some bits and pieces in vaccines that, in larger doses, would create an issue. But to address the specifics of the anti-vaccination nutters:
- Thiomersal (a mercury based preservative) has never been identified to create a problem, but due to potential risks it has been removed from the vast majority of vaccines since 2000, and in the 3 remaining (tetanus, diphtheria and Hepatitis B) it is only in trace amounts (5)
- Aluminium is present in many vaccines as it enhances the immune response. There are established safe levels of aluminium intake and vaccines are well inside the safe range. In fact you get a lot more aluminium from eating, or from taking Mylanta, than you do from a vaccine (5). Maybe the AVN should be onto that…
- Formaldehyde is the other chemical that tends to get raised, and it is used to inactivate the pathogenic organism in some vaccines. Testing by the Therapeutic Goods Administration found formaldehyde in a maximum concentration of 0.004%, which is well below the standard allowed of 0.02% (6)
3) Vaccines are contaminated with human and animal virus and bacteria
This is sort of maybe kinda once was true.
Now one example the AVN name here is “Reverse Transcriptase”. Only one small problem there, namely that reverse transcriptase is an enzyme (not a virus or bacteria) that is used to convert RNA into DNA:
http://www.britannica.com/EBchecked/topic/500460/reverse-transcriptase
It is a part of what makes retroviral diseases infectious, in the same way that an engine is part of what makes a car work. It is no more a retrovirus than an engine is a car.
The other example they provide is SV40, a monkey virus that they quite rightly claim contaminated the polio vaccine. Back between 1955 and 1963 (7). Before these issues were known about and tested for. But still, lets not be too critical that they are conducting a scare campaign based on 50-odd year old information.
Testing on vaccines is extensively done (8,9) to ensure they are not contaminated. The AVN go on to try and muddy the waters by association with HIV and Mad Cow Disease (or Bovine Spongiform Encephalopathy to give it it’s proper name). This is a case of trying to say “Look, vaccination hangs out with the bad kids, so it must be wrong”. But to address the issues:
- HIV has developed from a monkey virus called SIV. But ultimately most of our diseases have come from animals (insert your own chickenpox joke here). The whole history of vaccination goes back to Edward Jenner recognizing that milkmaids didn’t get small-pox, and figuring out that exposure to cow-pox stimulated the immune system to fight the disease because the viruses were related. The whole bird-flu and pig-flu scares were all about animal viruses crossing over to humans. Rabies lives in dogs, amongst other animals. Ebola virus is thought to be hosted by bats. This is not news, and does not make vaccination wrong. The spread of HIV was theorized for a time to be due to mass polio vaccinations in Africa, but follow up studies have shown this is unlikely to be the case (10, 11).
- BSE broke out because people ate contaminated beef or dairy products, with a handful of cases thought to be due to blood transfusion. Vaccination had nothing to do with it. All bovine products used in vaccine production in Australia have to come from BSE free countries (5)
To Be Continued…
References
1) Australian Vaccination Network: http://www.avn.org.au/ – but in all seriousness, this is not worth visiting unless it is to descend into a world of nonsense and bullshit.
2) NSW Health Care Commissioner – http://www.hccc.nsw.gov.au/
3) To see a summary of the Tuskegee Experiment – http://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment
4) Eldred B, Dean A, McGuire T and Nash A, “Vaccine components and constituents: responding to consumer concerns”, Medical Journal of Australia, 2006, Vol.184, pp.170-175.
5) “Myths and Realities: Responding to arguments against immunization”, 4th Ed, Australian Government, 2008.
6) Australian Immunisation Handbook, 9th Ed, Appendix 5, accessed 20/09/10 http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook-appendix5
7) Strickler H, Rosenberg P, Devesa S, Hertel J, Fraumeni J and Goedert J, “Contamination of Poliovirus Vaccines With Simian Virus 40 (1955-1963) and Subsequent Cancer Rates”, Journal of the American Medical Association, 1998, 279(4): pp.292-295.
8) Weiss R, “Adventitious Viral Genomes in Vaccines but not in Vaccinees”, Emerging Infectious Diseases, Vol.7, No.1, Jan-Feb 2001.
9) Vogtlin A, Bruckner L and Ottiger H, “Use of polymerase chain reaction (PCR) for the detection of vaccine contamination by infectious laryngotracheitis virus”, Vaccine, Vol.17, Iss.20-21, 1999, pp.2501-06.
10)AVERT website – an international AIDS charity: http://www.avert.org/origin-aids-hiv.htm
11) Worobey M, Santiago M, Keele B, Ndjango J-B, Joy J, Labama B, Dheda B, Rambaut A, Sharp P, Shaw G and Hahn B, “Origin of AIDS: Contaminated polio vaccine theory refuted”, Nature, 428, 820 (22 April 2004).
So the other day we’re driving to a job, with all the bells and whistles. My partner was driving (let’s call her Sharon), and I was in the passenger seat, doing my active scanning thing for potential hazards (as per official Ambulance driving standards). As we came up to an intersection, I saw a bloke out walking his child – a boy of maybe 3 years of age, who was on a little tricycle. The bloke was wearing an MP3 player, with the earplugs in, which makes him a hazard because he may not hear us coming. The boy is a hazard because he’s young, and can’t be relied upon to not ride in front of us.
As we closed on the intersection, the bloke looked like he was going to cross the street, so Sharon slowed a bit. The bloke then lifts his head and looks at the ambulance closing in on him. He made eye contact with us, then put his hand on his boys shoulder, and waved him on to cross the street in front of us. Sharon braked and brought the ambulance to a halt, and we watched this guy cross ahead of his son, leaving him pedalling frantically across the road with his dad safe on the footpath on the other side.
I joked with Sharon that she should have rolled forward and hit the boy, not hard enough to hurt him, but maybe just enough to knock his trike over. She declined as she didn’t think that would be teaching the appropriate person the lesson. We chuckled quietly to ourselves, and went on with our business.
Apparently in New South Wales they don’t treat these kind of incidents with the same leniency:
http://news.ninemsn.com.au/national/7955978/woman-dies-after-being-hit-by-ambulance
So, there has been some follow-up from the first bit, and it goes a little something like this…
First the good news. Ambulance Victoria has included a new bit in their recruiting process. It’s a maths test. This is in response to the recruits over the last few years being unable to do basic maths calculations, which is obviously a problem when you have to work out how much a 9 year old weighs (the equation is age X 3.3), then calculate a drug dose of 100mcg per Kg, and work out how much you give out of a 5mg per ml vial.
So the new recruits sit a maths test – and it’s basic maths, we’re talking addition, subtraction, multiplication and division – before being employed. And obviously, given that maths is such a key skill for paramedics, if they fail they shouldn’t be accepted into the job. Right? And so the pass mark is…sorry, what’s that? There is no pass mark? So they can’t fail then. OK. So the point of making them sit it is what exactly..?
And the not so good news? Well AV has told the new recruits for next year that each and every single one of them will end up in rural Victoria next year. For the Big Needle’s misgivings about this, see the first post about this.
It is important to highlight here that I am not trying to represent negative sentiments against the university recruited paramedics. They go to university and do their course, and learn what they learn, then they join AV and do what they are told. But I am negative towards AV, and the way they are treating the recruits. What do they learn if they can’t fail the recruitment process? And once they are employed, surely the onus should be on the organisation to ensure they develop the skills and knowledge to provide the best outcome possible when they look after members of the public.
Ambulance Victoria is not doing what it should be doing to provide the best quality care to the Victorian public. That worries me, as a citizen and taxpayer of Victoria, and it should worry you too.
Since starting this blog I have received a few comments here and there, humorous and supportive generally, that are always welcome. While I was on hiatus however, I got spammed. Web-based companies mainly it seems, sending comments that they hope will be published, including a link to their advertised product. So my initial excitement at suddenly having several hundred comments on my blog turned to disappointment at realising:
a) I am just another Spam victim, and
b) I have an enormous ego that assumes I will get famous writing a blog about ambulances, and that ego takes less than a second to fire up with dreams of wealth and a life of luxury.
But when it came to marking all the comments as Spam, I couldn’t help but find a couple of them accurate in their description of my blogs content…
i) “I have been surfing online a lot more than three hours right now, nonetheless I certainly not observed any interesting article like yours. It is rather worth adequate for me. In my opinion, if all webmasters and bloggers created fine content material as you did, the internet is going to be a lot more useful than at any time previous to.”
Thank you for finding my blog “worth adequate”, I think…
ii) “I desire you by no means stop! This is among the best blogs Ive truly study. Youve got some mad skill right here, guy. I just wish which you dont eliminate your design simply because youre undoubtedly a single of the coolest bloggers on the market. Please retain it up since the internet demands an individual like you spreading the word.”
Rest assured, guy, I will by no means stop using my “mad skill”…
But my favourite…
iii) “Rubbish. Utter rubbish.”
Succinct, clear, inarguable, and quite clearly the most honest feedback I have received so far…
So Brumby and Baillieu are going to have an Ambulance-Recruit-Off in the lead up to the State election. Baillieu says he’ll recruit 340 new paramedics, Brumby says 345, Baillieu says 30 non-emergency transport officers, Brumby says 32 of those, Baillieu promises 10 MICA units in rural Victoria, Brumby says me too, and so on it goes…
My questions are these:
1) Is there an identified shortage of paramedics?
2) Who will train the new recruits?
3) Could this money be better spent?
To address these in order:
1) There is a difference between a shortage of paramedics and an excess of workload, particularly when the workload comprises a combination of emergencies (heart attacks, strokes, car accidents, etc) and non-emergencies (my prescription ran out, Man-Flu, my baby vomited, etc).
If you look at the number of calls coming into ‘000’ and just want to make them go away, you employ enough people to send an ambulance to everything, which is what both Labor and Liberal are promising to do. Addressing the nature of the calls is admittedly more complex, would require some lateral thinking, likely some community education, possibly some specialists in the areas of mental health and social work available for phone consultations, and other strategies. A complex problem usually requires complex, multi-factorial solutions, and politicians prefer simple, easy-for-the-public-to-understand solutions that sound good. Like announcing how many paramedics they can recruit.
2) So we’ve decided to throw more paramedics at the workload, rather than analyse it and address the issues. And we recruit as many paramedics as possible (Brumby has stated he will get 234 recruits in a year) and throw them into the system. But they need supervision and training from experienced colleagues (known as Clinical Instructors) to guide them as they make the transition from university graduate to paramedic, so who will do this job? The ambulance service has failed to fulfill this responsibility for the graduates they have employed for the last 2 years, with recruiting numbers of around 120 a year, so how will we address it with almost double the numbers?
I’d love to offer some reassurance and say that AV have at least been monitoring the progress of recruits to ensure the lack of supervision is not causing problems for them, but in fact AV has decreased the level of reporting required on their progress, and has taken an “If you don’t take the temperature, you can’t find the fever” attitude towards them as a group. As long as they don’t kill anyone, resulting in the Coroner asking annoying questions, AV will get away with this.
3) So where would this money be better spent? Well part of it would be better spent on nurses. AV acknowledged in it’s 2008-09 Annual Report that ambulances getting stuck at hospital is a problem, because while waiting to offload patients means ambulances can’t respond to another job. This is a problem most days of the year at the moment, and won’t be fixed by putting more ambulances on the road. More ambulances on the road mean more ambulances arriving at hospital – all that leads to is a longer queue. The Federal Government health reforms are aimed at providing more nurses, which will open more hospital beds, and improve movement from Emergency Department to hospital ward bed, which makes room for ambulance patients. The State Government is working in the opposite direction, as will the Opposition if they get into power.
So what is the answer? Well in the grand tradition of “It’ll all be different when I’m King of the World…”
- Firstly, there should be a transparent needs analysis done to demonstrate how many resources the Ambulance Service needs, and more importantly where they should go. There is little doubt that there are rural areas that are under-resourced, and they should be identified and publicized outside of the context of an election campaign (to avoid marginal seat bias in resource allocation).
- Alongside this, the breakdown of AV’s workload needs to be published. If we are doing a large percentage of non-emergency work we should have the ethical gumption to refuse the dollars offered by both political parties, as it should be directed to other areas of the health system to ease the workload for all. Let’s be team players here.
- Thirdly, our recruiting should slow down, not speed up. We need to ensure our recruits are properly trained and instructed to do what is a difficult job, often done under extreme pressure, and with people’s lives in their hands. Our recruits should be scrutinized properly, to ensure they are not slipping through the cracks. At the moment I can guarantee some are.
- Lastly, there should be no new recruits sent to rural areas. If rural areas need resources, they should get experienced paramedics – even if this means using financial incentives to get them there. This job is hard enough when you are 10 minutes from hospital, and your backup is 5 minutes away. Now try it when your backup is 30-45 minutes away, and hospital over an hour. Now throw in making a new decision – do you want the helicopter? Now try all this as a new recruit, who has been under-supervised during your first 12 months. And given you were recruited and sent straight to the bush your experience base has been gained in areas where they do 30 jobs a month (as opposed to in metro where you would be at branches doing 300 jobs a month), so you are way behind in your professional development. To send new recruits to the bush is papering, with shitty quality wallpaper, over the cracks.
Well now I’ve fixed that, onto the Middle East peace crisis…
An old man died. He was old enough that you would think it foolish not to expect it in some way shape or form, but apparently his daughter didn’t. We had done our thing unsuccessfully, with the result we all knew was coming. She had been hysterical throughout the resus attempt, and upon being told we were stopping and he was dead she took it to a new level that I have not thus far in my career encountered.
She knelt next to the body and begged him to open his eyes and wake up. Then suddenly, and with accompanying shock and awe, she proclaimed: “He’s trying! Look, he’s trying to!”
Now at this point I need to make a confession – and no it’s not that I had attached a string to his eyelid and was tugging on it while sniggering behind my hand! I have seen the movie “Seven” many times, and a fine piece of cinematic art it is, but it has left me with a phobia. If you have seen it you may recall the scene where the guy who has been chained to the bed (Sloth, if I recall correctly) is declared dead by the paramedics, but then he moves as the detectives search the crime scene, and they have to call the paramedics back to take him to hospital where he ultimately dies. As a lay-person viewer you probably stay in the perspective of the detectives for this scene, and get the fright when the body moves, and then follow the investigation through to the next crime, but not me. I adopt the position of the paramedics, and wonder what sort of lazy-arse ambo doesn’t actually check to some degree of clinical significance that someone is actually dead.
But that has led to my phobia, and it is this: that I will, on that bad day when I’m off my game and my mind is somewhere else, declare someone deceased (demised, expired, gone to meet their maker, dead, a stiff, bereft of life, shuffled off this mortal coil, joined the choir invisibule, an ex-patient…) and then they won’t be.
So here we are in the small family kitchen, and the daughter declares her father is trying to open his eyes, and the conscious part of my brain says “No he’s not, you’re mad with grief”, but a small irrational part of my brain says “But what if he is?”
So I go across, put my arm around the daughter and try and convince her in unequivocal terms that he is dead and beyond any help, and at the same time convince myself that any movement she is seeing is her own movement disturbing the corpse (which it is). But she doesn’t come round to my way of thinking. So with the local doctor organized to pop over (hopefully with some heavy sedatives), we leave her in the hands of family and carry on cleaning up.
As she screams in the background “He’s trying to wake up!”, my partner responded under her breath (so only I could hear) “No he’s not.”
I nervously glanced back at the reassuringly-still-dead corpse and whispered “Or else we’ll look like a right pair of cocks…”
