Paramedics tend to think of our job as being quite physical. It is, but maybe not in good ways. This is my step counter, as recorded by my phone. I keep it running in the background and my phone is always on me. Wednesday to Saturday I was off duty. Sunday to Tuesday I was working on the ambulance. Notice the difference between the first four days and the last three? That’s right – when I’m at work I spend a lot of time sitting around. It doesn’t always feel like that, because I feel like I’m spending the day out and about. But in reality, my movement is mostly from the branch recliner t ..read more

Hello from the world of ambulances and other emergency services! We hope you have an excellent Christmas and holiday period. It’s a fun time and people are usually in a good mood at the end of a working year. It’s a time to spend with family and friends, to eat and drink, and generally try to reconnect with humanity. But please look after yourselves. Historically the Christmas period has been a bad time for certain types of problems. People often crash their cars at this time of year because they’re travelling long distances to see family. They may also be overtired or drunk, which is rarely a ..read more

Have you ever been annoyed at a change in your clinical practice guidelines? Have you ever been frustrated because of moving goal posts? Want to understand your clinical practice better? Start here.   1.  No-one knows what “right” is.  Occasionally I hear people complain about changes in paramedic guidelines. “I can’t keep up!”. “They’re always changing the guideline!” “Why can’t they leave things as they are?” Apart from acknowledging that “they” are hard-working paramedics like themselves, there’s a very simple reason for this: science. The truth is that we often don’t know wh ..read more

Sometimes I just have to scratch the itch and have a rant.  This time the itch is a recurrent one, about radio communication. We have a large number of graduate paramedics starting with Ambulance Victoria this year, so it’s probably a good time to revisit a topic that seems to receive surprisingly little attention in an industry that relies so heavily upon it. So, some generic tips for everyone new to talking on radios (and perhaps for more than a few who are not so new…) Talk less.  Radio air time can be a very scarce commodity.  We have a very large service, which is growing r ..read more

Ultimately, a lot of what we’re doing in EMS is ferrying people towards their deaths.  In the literally-true-but-irrelevant sense, we’re all dying. But that’s not what I mean. Pre-hospital and Emergency workers spend a lot of time around people in their final hours and days, even though we don’t always think about it.  It’s easy to get fixated on the “glory job”, the case where our care may be able to prevent the death of a young and healthy person. But those cases are relatively uncommon. Most of our time is spent with the very old and terminally ill. It takes a lot less to kill the ..read more

Head on over to Emcrit to read Rory Spiegel’s take on mechanical CPR.  I’m fairly sure Rory has been reading the sporadic ranting of a certain paramedic on this topic, hence his brilliant, insightful work.  I’ll let him have his moment though The key to mCPR being useful is selecting the right patient who can benefit from other therapies (and being good at applying it).   Some patients should not be resuscitated; some patients should; and some, who fail an initial trial of human CPR (hCPR), should be considered for mCPR as a bridge to further treatment.  Rou ..read more

Following on from my previous post on managing the agitated patient… Now that we know that these patients are sick, and we know why we need MICA support, we will have a look at some practical tips for managing the extremely agitated patient. First of all, we probably need to know what we are looking for to know if our patient falls into that extremely agitated patient.  Like pornography, you’ll likely know it when you see it.  Be on the lookout for: Destructive or bizarre behaviour generating calls to police Suspected or known psychiatric illness Suspected or know psychostimula ..read more

Link time: First10EM.com has published an interesting article/brain dump on performing under pressure in the setting of emergency medicine. There’s a lot in there, but the key takeaways are that “stress” is inevitable, but varies a lot from person to person. The trick is to optimise your response to stress so that it helps you to do your best work. Have a read ..read more

It’s time for another post on everyone’s favourite drug: ketamine!  Hooray! Ok, so this is not entirely about ketamine, but ketamine does come into it.  AV paramedics have recently received training to administer IM ketamine to agitated patients as part of a greater focus on paramedic safety when managing these situations(MICA paramedics have had ketamine for a while, it is now used by all paramedics) Speaking with crews since the roll-out, there seems to be some confusion around some  aspects of managing these patients, so I thought I would attempt to exacerbate allev ..read more

Just when I thought I knew what I was doing…along comes a study to prove me wrong. This time, it’s therapeutic hypothermia (TH) in the post-arrest patient.  Published today is another paper from The Alfred ICU on TH post Out Of Hospital Cardiac Arrest (OHCA), designed primarily to confuse me (and many others I suspect). The article is in Resuscitation and is behind a paywall at the moment: Changing target temperature from 33°C to 36°C in the ICU management of out-of-hospital cardiac arrest: A before and after study. As you all know, TH was the intervention du jour for OHCA for some time ..read more