First placement 25th November - 20th December

The course has been pretty full on and intense therefore updates have been lacking I’m afraid, but now everything has calmed down a bit I’m back-dating a few blogs and can now keep up to date with everything from now :)

So time for placement no more classroom training for the next few weeks, its time to get on the road. I met my mentor on the first day, this is the paramedic I will be doing the majority of my shifts with, and luckily we get on well.

Probably the first important and invaluable lesson that has to be learnt quickly is your chief responsibility………tea making, and lots of it!! Once you have mass tea making down at all hours of the day and night its time to start applying what we have learnt so far in the real world, easier said than done!

So my first emergency call came through, and after being thrown around in the back of the ambulance en-route, (that’s where the students live in the back of the ambulance as the front sits only two) the call was a patient with difficulty breathing, and a trip to hospital was needed. Initially my focus was on taking observations on patients; pulse rates, blood pressures, blood sugars and generally assisting where I can.

The next few weeks I began to gain confidence in the basics and became more familiar with how things work in the pre hospital setting, you never really know what call your going to get next, which is part of the appeal of working on the ambulance. One of the things we do as we approach a patient is assess their appearance and undertake a primary assessment to determine if the patient is time critical or not, up until this point we haven’t had anything too serious.

But then the call comes through, its something we have practiced a lot in training school but nothing can really prepare you for the first one, it was a cardiac arrest call, we gathered all the necessary equipment while en-route on blue lights, we pulled up and dashed to the scene, and this point I think I learnt that the colour of adrenaline is brown!!

Lots happened very quickly the patient we were called too, was in cardiac arrest when we arrived and bystander CPR was underway, we took over. I started on chest compression, while the crew was working on intubating, cannulating and giving the appropriate drugs to the patient, unfortunately the patient’s heart rhythm was in asystole (more commonly known as flat line) this rhythm remained throughout and after 20 minutes we called it on scene. It was a strange experience stopping chest compression, the coroner was contacted and police followed shortly, its routine procedure in any call like this.

As soon as it started it was over, the last six weeks working on the ambulance has been a great experience and we have seen a large number of calls, but now it’s back to uni for another term, hopefully everything we will be learning should all make a lot more sense now we are more familiar with the job.

OSCE's and Driving

Last week saw the end of our time at university, and guess what, it was exam time. Well an exam of sorts, the grading of the course is varied with written papers, placements competency, assignments and OSCE's.

Now OSCE's involve you being observed doing a scenario and tested on your safety, and that you provide the right level of treatment for the patient you have been presented with. The pass grades for these are pretty steep at 70%, any mistake you make you are marked done by 10% and any major mistakes that compromises your safety or the safety of your patient is an instant fail, so no pressure :)

Our OSCE was a cardiac arrest with defib needed, fortunately we have done this to death, no pun intended, and I passed, which is a relief. I can now concentrate on placement now without worrying about it.

I am not completly free of tests however, as you may guess a major part of working on a ambulance is driving. I already have a car licence but am required to have the C1 category on my license to drive large good vehicles (LGV), so next week I have another theory test if I pass that I can go straight onto the LGV driving practical, which is a week long training and then the test. It will be good to get it out the way, although I fear I have picked up too many bad driving habits!! Of course once thats out of the way, then comes blue light training :)

Placement and explosive situations

As I mentioned in my last entry there is only so much that can be learned in a class room, that is why the structure of the course has a certain number of weeks at university, followed often by six or more weeks out on placement within the ambulance service. Now in a little under two weeks we all start these placements, and that means we have all been split up in to various ambulance stations across the south, in most cases three or four students at each station. I am working in a ambulance as a third person up until christmas, and all my shifts I will be working with my mentor, who I will meet soon.

Now mentors are different to our tutors, mentors are paramedics in the ambulance service, and as well as doing their job they have to look to after us students. This means attending a patient and deciding what we are capable of doing at different calls. This being our first placement, initially it will be observation and then integrating what we have learnt so far in uni, on the road. I will be sure pull my weight back at station however, in one of the most important roles of the student, that of course will be tea making duties!

So hows the best way to prepare for this placement block, yeah, thats right, scenarios, and lots of them. This week we had 2 full days of scenarios, ranging from cardiac arrests, stroke victims, asthma attacks and the big finale scenario to round off the week.

Now this scenario would be described as a Major Incident, it required 5 brave/foolish students to be patients for us to treat. There were also couple of dummies getting in on the action, so quite a few casualties. Now besides this the rest of us had no idea what was in a store, but it didn't disappoint, we were paired up to act as a crew turning up on scene. We were then deployed one crew at a time. Now the scenario was an explosion in a building, the fire service had deemed it safe. My 'crew mate' and I went in as the 5th crew and were directed down stairs. I think this is a good time to mention that there were screams coming from everywhere, and they were really selling it, it was definatly believable. We were directed into what can only be described as a basement/boiler room, that split in two sides, one side was full of various screams, and had crews attending. The other side, and the crew we assisted, their patient was silent....oh crap! Now as bad as it sounds, screaming is sometimes a good sign, it shows the patient is conscious and has an open airway, now the quiet patients, there the ones in real trouble. The first crew were well into CPR and had a defib attached, we took over CPR upon arriving, and the first crew continued to shock the patient every 2 minutes.

It was a tiny little area we were in, under the stairs, and no easy way in or out, you gotta love our tutors, if nothing else they have a good sense of humour. We were also working in near darkness, and we were relying on a mag light to see everything. After examining our patient we discovered he had a serious bleed from the leg, and I promptly applied a tourniquet which seemed to do the trick. (a tourniquet can be used on limbs to cut off circulation to a leg or arm, used when there is a serious injury preventing excessive blood loss)

In total there are 4 of us rotating on CPR and we really needed to get this patient out, however this is when things started going wrong, we had no spinal board, they were being used else where, so in the end we were down there for 20 minutes doing CPR it was hot, dark, and extremely sweaty business. When we got an extra spinal board and got the patient on the spinal board, we had the problem of our exit route, it was extremely narrow and made lifting our patient out very, well entertaining, but finally day light was upon us and our patient was out! We however were a mess, dripping with sweat, covered in dust but it was good experience.

Everyone after the scenario was in a similar state, and all looked, well pretty knackered. I think we all relised at this point just how much there is to learn and prepare for, fortunately we are all still a good 2 years from qualify, so plenty of time for that yet :)

Scenarios

Training as a paramedic is great, but its not what you would say a normal educational experience, there is only so much that can be taught using power points, thats why the rest of time were practicing practical skills and applying what we learn into scenarios. Scenarios can be any patient, any situation, in whatever condition your tutors like, so try not to annoy them and hopefully your get good ones.

At the moment we tend to do 1 or 2 scenarios a week, which are progressively getting more challenging, and are based around what we have studied so far, so you guessed it, lots of CPR and airway management, and then shocking if necessary. The hardest thing about scenarios is you need to treat the situation as if it is real, which can be tricky when you know your in a warm classroom, with your tutor a few feet away, and your tutor is answering any questions you have for the patient. Remembering most of the time in scenarios your patient is in fact, yup you guessed it a dummy. When in this scenario a person has just collapsed and gone into cardiac arrest in the middle of a busy shopping centre, tricky.

I talk about the dummies quite a lot, they are actually quite technical pieces of kit. The dummies we use most often, can talk, breath, provide heart rhythm when the defibrillator is attached, and they have 'lungs' that inflate when you use bag valve mask (essentially used for getting oxygen into the patient, which means we can avoid mouth to mouth, which is always nice) so a good bit of kit, which helps to make these scenarios all the more real.

The beginning!

Hello and welcome to my blog, this first post is gonna be big one, so get a brew on the go! This blog is a bit of a late starter, the course actually started at the beginning of october, with so many new things happening it was very hard to find time to start this blog. However as things have started to settle down now, I am excited to be able to write this blog, so it would be rude not to share some of my experiences so far.....

The first week!!

It was always gonna be a nervous affair, everyone going crazy introducing themselves, and getting to know people, and it didn't disappoint. :) the course itself consists of 30 people, a lot of names to remember on your first day! Everyone on the course seems nice, and are equally excited about the opportunity to train as a paramedic, which is great as I can't wait.

Okay time to pause, the truth is I have been waiting, for nearly 2 years for this course to start, as I was originally offered a place on the course in 2007, as a deferred entrant, because of the popularity they had filled that year completely, but thankfully I was offered a place on the following year, which is now 2009.

So the first week was a lot of getting to know you getting to know us, we had talks from various paramedics, that would be our tutors throughout our training, again a very nice bunch, with lots of info and support to share!

The second week!

This is the first real week where we started learning paramedic knowledge and skills, to sum it up breifly, CPR and Lifting!
It was in all honesty a tiring week, both physically and mentally, the start of the week involved lots of anatomy, just remember, air goes in and out and blood goes round and round. :) Then came the second part, CPR and lifting, at this point you can go ahead and cancel any gym memberships you have, effective CPR is incredibly tiring, and as hard as we tried, that dummy wasn't coming back to life :) then comes the lifting, basically a 10 stone deadweight dummy in a carry chair up and stairs all day, but being realistic 10 stone is light, there gonna be larger that life patients out there, our poor backs!!

The third week

Lots and lots of info, and the introduction of our books, it is in fact a jaw dropping moment when you are giving a book, that is so large that if dropped on someone would probably ironically require an ambulance, but a bit of bed time reading to take away! This week is beginning to sound a bit dull I hear you say, nope we got to play with defibrillators, so now the dummies get to be beaten up by us during CPR and then shocked with a defib, the good news we did save the dummy.
The fourth week

Respiratory system as mentioned earlier air goes in and out, we covered loads of info. All of this however is massively over shadowed by the introduction of our uniforms, needless to say it was exciting, and it was amazing how professional we all look wearing green. (green is great, it's my favorite colour, but I must stress that in no way did the colour of uniform influence my decision to become a paramedic, well not much anyway) for me everything became very real after putting on the uniform. Which is good placement is only a few weeks away now, and we will leave the comforts of the classroom and get to experience exactly what were training to do.

The fifth week

This week saw us talking about the cardiovascular system and the various disease's that can effect it, and also gave us a introduction to ECG, or Electrocardiogram, you have probably seen these before, either in hospital or on TV, (they are the squiggles on the monitor that flat line and then everyone panics) they are truthfully quite tricky to grasp, but it is something that will come with time, well hopefully anyway.

Right this brings us up to date nicely, there have been areas I have missed out here, but it is amazing how much we have done and learnt in such a short time, I am hoping to be able to update regularly and provide a lot more detail over the coming weeks, and fill in some of the bits of I missed out in future blogs!