Student Paramedic Placement: 5 Weeks In...

Placement is such a hectic place! Due to my shift schedule I am five weeks in but have done 4 blocks due to the four days on, five days off schedule. Somehow I am currently working almost full time over the placement block. I will finish at 6.30am on my last night shift, come home and head to sleep until 12pm, wake up and head to work. This is a great way for me to be able to afford placement, but I don't have a life! It is very difficult acting this way, especially as I am either on placement or asleep the rest of the time. Fortunately due to the crews I am working with, I am enjoying the shifts so much it feels less like a job and more like a lifestyle.

Update on my First Five Weeks

I have had such a variety of shifts. I am placed on the border of London, but as we do not respond to London Ambulance Service (LAS) calls, we can only head out in one direction, which means we regularly finish (very) late. On the plus side, you must have 11 hours between shifts, so usually if you finish two or more hours late you will get your shift time delayed for the following day, however if you finish one hour late then you still have to come in on time. If our start time is pushed back, I usually have to leave home at the same time anyway due to the traffic situation so it really makes little difference to me.

111 calls can provoke annoyance for paramedics as sometimes calls to 111 may seem life-threatening, but when on scene they seem unnecessary for an ambulance to crews. It is important to treat all patients with the same respect whether or not it seems 'unnecessary' for an ambulance to be called out as either, they think they need an ambulance, or the call handler does. It is definitely not worth the risk to not send an ambulance as it seems 'unnecessary' because it actually may turn out to be worse than reported. Over the last couple of weeks I have seen suspected meningitis in an adult male, abdominal pain, lots of worsening COPD cases (which improved my airway management for COPD technique), falls and a few fractures. Also over the bank holidays we did see cases of alcohol abuse and intoxication which definitely put me off drinking! Over the weeks I have noticed that certain jobs will always stick with me whilst others I forget within a couple of hours, which is a shame.

Due to a problem with my placement shifts, it was decided last minute to keep me at the same station for the following five weeks which is really exciting as my mentor and I have a great relationship and the area in which she works is really great.

My First Cardiac Arrest

This week I went to my first arrest which was a hanging. A single crew on a Rapid Response Vehicle (RRV) and a manager was already there so we were not first on scene and Advanced Life Support (ALS) was already underway. We had problems finding the location to begin with, and then I walked in with all the kit but had no idea what to do. I watched our crew mate jump in on the chest along with my mentor whilst I was left to get kit out. The scene, although hectic, was well managed. Helicopter Emergency Medical Service (HEMS) arrived on scene and were incredible. The doctor asked for a handover, which was given, went to speak to the family to find out more information, then came back and discussed options with us (whilst resuscitation was still underway). We placed the patient on an AutoPulse (automatic chest compression machine) to deliver higher quality chest compressions. He went through this checklist in his head and we tried different ideas to bring our patient back. He also discussed potential 4Hs and 4Ts with us (reversible causes of cardiac arrest) and we discussed giving naloxone in case of an opiate overdose, however due to an unlikely history and no suggestions of drug use it was decided against.

Unfortunately our patient did not recover a pulse so we had to cease life support. I did not get to do compressions, however I helped to move the patient, take a BM (blood glucose measurement) and clean him up. It was my first dead body which was slightly surreal. We ensured the patient looked presentable for the family and all rubbish was cleared up to make the scene less disturbing. After we cleared up, we had to take HEMS back to their hangar (as it was getting dark and they are unable to lift off after sunset so they left their crew with the patient), and went back to station for a debrief. HEMS are so calm and organised, it was incredible to work with them despite the outcome for our patient. They suggested I should join them with a shift on the helicopter for experience which I am going to try and get on the waiting list. At the debrief, I spoke to the first paramedic on scene who explained the paperwork and showed me how they used the Corpuls monitor to record everything they did during the arrest. The arrest did not upset me, but I think it would have been worse to be first on scene. The worst part of the arrest was the families response as it is completely heartbreaking, and made me want to go home and hug everyone so tightly and tell them I love them. Our debrief was helpful as we discussed what we were happy with, anything we wished we had done and any issues. We then went back on shift at 12am to a night full of hectic calls, and it was not even a full moon!

What I Have Learnt:

• It is okay to admit that you are unsure, or completely clueless. Placement is a learning experience and there is no way that you need to know everything. Asking questions and researching things yourself is a great way to embed knowledge. If something comes up in the description of the call which you do not know what it is, either ask or google it! This also goes the same for drugs that you are unsure of what to do. Use BNF to research drugs: their purpose and side-effects. This is important for second year pharmacology as will give you a head-start.
• Jump in, get involved. Always be ready to get your hands dirty and ask if you want to do something, especially if it will get your portfolio signed off.
• Make sure your mentor/other paramedic signs your portfolio! It is very stressful seeing lots of empty spaces in your document. 
• If something upsets you, speak to someone about it. If it is a patient, a job or a situation, talk about it. The best way I have found it to talk to another crew mate about it, and another one, and another one. Every time it is discussed and even laughed about, it becomes more normal and less of a weight on your shoulders. If that does not work, speak to the university or trust regarding someone to talk to. Do not let it weigh on your shoulders. Sort it before it mounts up.
• Final thing, do not forget your belt!!! Being on a call and having to pull your trousers up every two minutes is not a good look.

I hope this was an interesting post. If you did find it interesting, please let me know, share and give me a follow! I am trying to include more specific terminology into these posts for future paramedics as I did not know what half of it meant and had to ask!