Reflections on my 2 week Queensland Ambulance placement

I did my 2 week end of year placement with Townsville’s Hugh Street Queensland Ambulance. I rode along with 2 advanced care paramedics. I did 2 lines (lol doing lines make me sound like I’m doing coke) with them – basically 4 back to back 10 hour shifts with a 2 or 3 day break (can’t remember if it was 2 or 3) followed with a 4 back to back 12 hour shifts. The 2 paramedics I worked with worked very well together, were laidback and were very approachable individuals which greatly helped my learning as I never hesitated to ask any questions.

One thing that really resonated with me was their excellent bedside manners no matter what hour of the shift it was (boy oh boy, the 12 hour shifts were pretty brutal especially during the wee hours of the morning- I did fall asleep at one of the chairs while waiting for the patient to be admitted to ED and one of the paramedics got a snapshot of me doing this...very professional, of me I know). Be it infants, middle aged or older aged individuals of the same/ different race or gender, they were able to connect on a level with them for them to give them the sort of trust such the patients felt comforted. At the same time, the paramedics could also get a good medical history.

During these 2 weeks, I mainly observed though I got to auscultate a patient. That’s the extent of “clinical skills” I got to do. Taking blood pressure manually was out of the question since they carried automatic bp cuffs and I was completely fine with that. I was told to cannulate but I wasn’t trained to do so, so I graciously refused. Despite just observing though, I learned a wealth of knowledge with regards to ECGs, types of drugs administered and the methods by which they are administered that affected the drug efficacy. Some cool things I learned that I can’t wait to practice (who wants to be my pretend patient?!?!)

- For cannulating patients, you have to start in the distal arm before trying it in the cubital fossa

- I learned how to find a good vein to cannulate properly and how to cannulate patients in a bumpy vehicle (it requires some skills for sure!)

- For psychiatric patients, you can directly ask them bluntly if they wanted to commit suicide and expect them to give you an honest answer (how about that for not beating around the bush?)

- They can administer oral glucose (glucagon), glucose via IV or via intramuscular injection (which I thought was pretty cool because when I was volunteering on SERT we only carried oral glucose)

- Patients with angina are usually prescribed with beta blocker drugs that help lower their heart rate, so when these patients are administered GTN (glycerol trinitrate) without having their blood pressures checked (uh-oh! Bad news bears), their heart cannot compensate the loss in blood pressure

- They administer various pain relief medications:

o Methoxyflurane (inhaled analgesic)

o Morphine sulphate (injected analgesic)- this one has stronger side effects like vomiting and nausea

§ It also lowers blood pressure so you’ve got to be careful if you wanted to use them in patients who just used GTN aka nitroglycerin

- Other than learn cool things, I got to visit quite interesting places. I got to see the inside of a holding cell at a police station, went and treated a prisoner (to be honest I was a little scared haha), got to visit Palleranda Beach. I definitely got to see more of the things I don’t see on a daily basis (i.e domestic violence/ assault). The one thing I wished I got to treat and didn’t get to treat was a drunken disorderly. I thought it would be fun since it would remind me of SERT and responding to all those drunk students saying gibberish and remembering, at one point in my life, I was like that.

In 1^st year of med we learned about interprofessional relations multiple times between healthcare professionals and it was during this placement that I saw it in play firsthand (between the triage nurse, the ED nurses, paramedics and the ED doctors and you could say the cops as well). The handover of patients to the triage nurse at the emergency department had to be concise. The paramedics had to paint an accurate picture and how significantly it affected patient care outcomes.

The most memorable activity that I undertook was transferring a patient to the Royal Flying Doctor Service. This patient was being sent home for pallialitive care. His partner was very emotional and I was also getting very emotional as well as she started talking about her children and how hard it was to lose the father of her children. I decided to steer the conversation away from her dying husband and got her to talk about her children and her future aspirations of them. This particular case was so memorable to me because I was moved to tears by a stranger (though I tried very hard to hide it) and felt her pain and felt honoured in a strange way that I got to spend the last few days of his life with him. What was also heartbreaking was the fact that the paramedics had told me that her husband might not even make it through the night due to his deteriorating condition and her not knowing it, but at the same time, me feeling like it wasn’t my place to be telling her that for fear of making her feel more devastated. In a way, I felt helpless. The bright side of things were that he had one of the most aggressive type of brain tumour and had 2/1/2 years of healthy life despite being only given 8 months to live. (I’ve changed the number of years and months to preserve confidentiality)

That’s the beauty of the healthcare profession. You see people on their worst days and at their most vulnerable and you hope that somehow you’ve helped in some way or another and though sometimes you’ll know, other times you’ll never know. I think what’s most important is that you did your best with the knowledge that you have.