Monday, February 20, 2006

Paramedic Interview

Well today was the big day, 1110hrs in Galashiels, I arrived and waited patiently until I was called in, there on the panel was a Station Officer (Area Service Manager for A&E) from Edinburgh, the Training Manager for my Division and a Anaesthetic Consultant sitting behind the desk, I swallowed hard, took a deep breath and tried to relax as I sat down. The interview lasted 20 minutes (only scheduled for 10) lots of questions from them all and then it was my turn to ask them some questions.... I asked about the academic aspect of the paramedic course and will the service be going towards external recognition from universities for the training, I wanted to know what the service stance was in regards to staff looking to enhance their knowledge in relation to their continued personal / professional development and what support did the service offer to these staff.

The Training Manager told me that they would be calling all the candidates later today...

Well 1500hrs and "Ring Ring" Hi SMM it's Training Manager (aka GOD), I just want to say congratulations and I would like to offer you a place on the 2nd of April 2006 course!!!!! Is that ok? "Gulp" Eh yeah I think that should be ok.... (SILENTLY SCREAMING YEAH YEAH OH YES inside).

Oh well better dust down the books again!!!

Agenda for Change (New pay scheme in NHS)

Well I am sure that some of you will have received your A4C letters outlining your new salary.... for those of your who are not up to speed with the whole A4C fiasco it has taken nearly 3 years for the Service and unions to agree the terms and conditions of this new deal, there has been rumours flying all ways in regards to the payments that staff will receive and how staff will be better off because they are now getting paid for working "Unsocial" hours (between 7pm and 7am Mon to Fri and all day Sat and Sunday), disturbed meal breaks and public holidays. Well the big day arrived on Saturday and the brown stuff well and truly hit the rotating thing at a great speed... basically as a qualified Technician within the SAS you can expect to earn £22,271.00 basic salary, with my weekend hours I get a further £495.56 that gives me a grand total of £22,855.65 now that sounds not bad so you would expect that the A4C payment would match or better this.... Well my new basic salary is £19,248.00 YES that is £3,023.00 less than what I currently earn, once I receive my "Unsocial" payments which because I am relief is calculated on a 3 monthly period unlike the permanent board members who receive 25% flat rate payment, I come out with 17% which equates to £3,272.16 giving me a new grand total of £22,520.16, now for those of you who can count that is £335.40 less per year than what I currently earn so I have that difference protected. This means that I am no better off and potentially I will lose out if my "unsocial" % changes in the next 3-month reference period!!!!

We have also been offered a £250 per year payment for having our meals disturbed along with £5 per shift regardless of how many times we are disturbed, this means that technically you could work 12 hours and have 5 or 6 disturbed attempts at a break or no break at all and only receive £5!!! One of my colleagues worked it out that they would get 80 pence per shift if they continue to have their meal disturbed at the current level!! (Can't find anywhere that sells replacement meals for 80p)

As you can gather there is a lot of unhappy staff within the service at the moment and it seems that the unions have taken 3 years to negotiate a pay cut for Technicians!!!!

Thanks guys

Tuesday, February 14, 2006


Well this is the code that means you are going to a patient who is "Not Alert" following a CVA (Stroke).

So we arrive and because of difficulty in parking, I walk to the house with my oxygen and response bag and my colleague follows eventually with the defibrillator, once he can safely park the Ambulance without drivers thinking that they have the right to totally ignore all rules of the road and common courtesy. As I walk towards the house the patient's son tells me "I think my Dad is now dead!" so in I go and true to his word the patient was lying slumped in his wheelchair not breathing and no pulse.

I get the patient on the floor and start my CPR protocol, securing this 78 yr old mans airway with a plastic curved tube called an oro-pharyngeal airway (OPA), breathing for him with a Bag and Mask connected to my oxygen and start jumping up and down on his chest. As I am doing this my colleague walks in and quickly connects the defib to the patient and we find that he is Asystolic (flat line) so my colleague (who is a paramedic) confirms that I have a good airway for the patient and begins to cannulate (place a small plastic sheath and needle into a vein) him, we give some cardiac drugs and continue with CPR, because of the tightness in the house, we decide not to intubate (pass a larger tube into the patient's airway) until we are in the vehicle. Following this decision my colleague gets the son to help him gather further equipment and returns, but whilst my colleague is away the patient decided to change his heart rhythm and I am able to deliver an electric shock to stun his heart (defibrillate) into a rhythm that is able to sustain life! With one shock his heart starts beating normally and he slowly starts breathing!!!

Once in the Ambulance we intubate him to secure his airway properly as he was still not breathing sufficiently on his own, we blue light him into hospital and are met by the full resuscitation team in AE and hand over his care to them.

Upon cleaning and clearing I pop back in to check on his condition and his heart is still beating, he is breathing with less assistance and he is being prepared to be moved for further investigations.... as I walk out the Consultant who was looking after him says "Well done" now I know that it doesn't sound much but when you have worked as hard as my colleague and I did it is nice to feel as if you have at least given the patient and his family a chance!

Will see how he is getting on tomorrow and keep you all updated.... if you want?

Monday, February 06, 2006

Oh that's got to hurt

Well I was working 7-7 day shift at a neighbouring station today and it was your run of the mill calls, elderly patients who had fallen and possibly fractured their hips etc.

Well all that was to change, at 1330hrs we get the do do do doop noise as we are pulling into Livi to give the outside of the Ambulance a quick clean, so pulling back out of the wash bay we are heading out of the station lights and sirens going to a call at a local industrial estate for a 'Male hit by sheet metal' we arrive to be waved in the direction of the patient, who is lying on the floor beside a very large machine, in obvious pain, but still fully conscious.

I am driving for this half of the shift so my partner goes to assess the patient whilst I gather some extra information from the patients colleagues. My partner shouts to get another crew with a paramedic for pain relief, I head back and gather some further equipment and call up to the EMDC at the same time requesting the second 'paramedic' crew and head back.

Our patient is given entonox for the pain before we even begin touching him, but we can see that this will not work that well and hope that the second crew are not that far from us.

Now the patient is a male in his 30's who has been working at a machine when some sheet metal struck him in both the legs just above his ankles, this caused one of them to snap and the other leg ended up being fractured (#) and the foot was rotated 180 degrees, causing the bones in that leg to tear through the skin.....

The 'paramedic' crew arrived and gave the patient more stronger pain relief, set up fluids because of the blood loss and shock and we then had to gently move the fractured ankle into box splint so that we could then move this leg off the one underneath which was the rotated open fracture (more serious due to the possibility of loosing the foot if the blood supply is restricted beyond the site of the injury).

Once we had the # ankle supported and moved out the way we could then see the full extent of the injury and begin to manipulate it back into line (we had to remember and turn it the right way!!), now the feeling of crepitus is not a nice one and I have only felt it once before, but today I was supporting this limb as my colleagues applied traction above and below and we all turned together, straightening the patients knee out and making sure the foot was pointing in the same direction as his knee, my hands were under the fracture, holding on the sterile dressings to control the bleeding and supporing the bones and I can honestly say if you want to feel crepitus then get some chicken bones, snap them and then rub them together in your hands!!

Once our both the legs were stabilised and the patient was feeling the effects of the pain relief medication he was lifted onto the trolley bed in the Ambulance and the 'paramedic' crew transported him to hospital, leaving me and my colleague to tidy and re-stock our vehicle and reponse bag because we found out that the 'paramedic' had used all our equipment! Thanks mate!

Oh well I guess that the patient will now be lying in a hospital bed, possibly following surgery today and looking forward to a fairly lenghty recovery process, well at least we managed to do something good for a change :)