A new direction

I have removed most of my posts.

I was spoken to by management about their concerns over some of the content of my blog, thus I've removed nearly all the posts. Also, apparently there is a policy document about taking photos whilst at work. So the images have been removed.

I've copied all the posts back to my computer this time, so at least I can re post what is deemed appropriate after some more editing.

This means, I can have a work related blog, but with a more limited focus. That's fine with me. Don't want to do anything to jeopardise this great job.

Things will be lean on the posting front for a while as I'm very busy. About to go to Melbourne for 4 weeks on the Monash Uni Aeromedical Retrieval course and will have an exam and several assignments to do.

Til then, be safe.

What's On Our Pagers

I wrote a similar post to this one, prior to the deletion of the blog, so here is the information again.

Our ambulances don't yet have GPS (apparently they are coming, maybe, who knows...) or data terminals. Another blog I read mentioned that they received their jobs via the PA at the station.

In Tasmania, we carry pagers and receive our jobs via them. If the job has some intricate details or the communication officers want to give us a "heads up" on the patient we are about to deal with, then we are rung on the mobile phone each truck has, to receive the extra information.

Here is an example of a standard pager message:

IN0154E 764
UNIT 2 / 123 THAT STREET,
SUBURB, 7012 Sa:86e5 NORTH
UNCONSCIOUS, DIFFICULT TO ROUSE,
? OVERDOSE
BLOGGS, JOSEPH, 34, M
12:34P 22/05

What does it all mean:

IN0154E - Incident 154 for the state since midnight and the response code is an E - Emergency (lights and sirens).
Could also be an U or a D
U - urgent, respond immediately, but no lights and sirens
D - domestic, respond when clear or after the meal you just started (we very very rarely get D jobs).
764 - our ambulance number, confirms it was meant for us ?

UNIT 2 / 123 THAT STREET, SUBURB, 7012 - Address of the incident.

Sa:86e5 SOUTH - Street Atlas, page 86, grid reference e5, Southern Region - T.A.S is run under 3 regions.
Sometimes it will have Mb:123w23 - Map Book, page 123, etc if the job is in a rural area.

UNCONSCIOUS, DIFFICULT TO ROUSE, ? OVERDOSE - General description of the job from what the Communications Officers has been able to obtain from the call, sometimes way off, but usually very accurate.

BLOGGS, JOSEPH, 34, M - patients name (if available), age (often estimated by caller) and sex of patient.

12:34P 22/05 - time and date of pager message.


We no longer complete our reports on paper.
We use a Panasonic TOUGHBOOK which is referred to as a VACIS (Pronounced VAC-ISS and stands for Victorian Ambulance Clinical Information System). I know Victoria (obviously) and Queensland also use them and other states are in the process of getting them. I may do a future post on the joys of using these.


Til then, be safe

Another Block

The last block held the following jobs for my partner and I.

The jobs below are listed as:
Called To (as listed on the pager) -> Result of the Job

Unconscious/Fainting -> N.A.D.
Breathing Problems -> SOB
Transfer RFDS -> Transfer
Conditions Specific -> Post-ictal
Red Cross Alarm -> Cancelled
RTC -> Trip & Fall
Overdose, Police requesting assistance -> Substance U/K
Fall, Hand Injury -> ? Fractured arm
Traumatic Injury -> Post LOC / Concussion
Chest Pain -> Chest Pain
Transfer Home -> Back to Nursing Home
Abdominal Pain -> ? Abdo pain for investigation
Overdose -> Antidepressant Poisoning
Unconcious/fainting -> Cancelled by police
Pregnancy -> Born at hospital 15 minutes after arrival
Breathing Problems -> COPD, very ill
Sick Person -> Inner Ear Problem
Haematemesis -> Panadol & ?? Overdose
Chest Pain -> Rapid Af
Condition Specific, Chest Pain -> Pleuritic Pain
Breathing Problems -> Asthma


Til then, be safe.

Upgraded skills of a Tasmanian Intensive Care Paramedic

Again, I previously posted (before rashly deleting the entire blog) most of the following information.

Tasmanian IC Paramedics previously did an in-house course lasting about 6 months but I recently completed an Advanced Diploma of Paramedical Science (Ambulance) over 9 1/2 months to obtain my Intensive Care qualification. I understand T.A.S. are still planning on moving to a Graduate Diploma of Emergency Health (MICA Paramedic) through Monash University in the near future.

These are the upgraded skills of an Intensive Care Paramedic over those previously posted as Paramedic level in Tasmania (again this list is not complete but you get the idea):

12 lead EKG interpretation
Endotracheal intubation and cricothyroidotomy
-> Sedation to maintain the ET tube
Capnography
Gastric intubation
Chest decompression (12g cannula)
External jugular cannulation
Intra-osseous cannulation
Synchronised cardioversion
-> Sedation for cardioversion
Enhanced pain relief (Morphine and Midazolam)
Extra cardiac drugs: Adenosine, Amiodarone, Atropine, Lignocaine, Sodium Bicarbonate
Extra IV drugs for: TCA & Psychostimulant OD's, APO, Asthma, COPD, Anaphylaxis, Vomiting, Meningococcal Septicaemia, Crush Syndrome, Organophosphate poisoning,
Full Paediatric Guidelines & Pharmacology


And just for some extra information, here is what I've heard around the station, should be coming to Tasmanian ICP's at some stage in the future, as other states already have them.
It may be years before we get some:

Rapid sequence intubation (RSI)
Thrombolytics
Transcutaneous cardiac pacing
Dextrose 50% - changing to 10% for hypoglycaemia
CPAP for APO
Syringe drivers for accurate drug infusions
Amiodarone infusion for conscious VT, before Lignocaine
Magnesium for severe asthma
Intranasal Fentanyl as another option for pain relief


Til then, be safe.

Becoming a Tasmanian Paramedic and our current skill set

I previously posted (before rashly deleting the entire blog) most of the following information.

Becoming a Tasmanian Ambulance Service Paramedic can be done in 1 of 3 ways: (Cut and past this link for some info)
http://www.dhhs.tas.gov.au/careers/ambulance_officers
or e-mail: wolfgang DOT rechberger AT dhhs DOT tas DOT gov DOT au

1) being hired as a "student" and completing 3 years on road whilst completing an Associate Degree in Paramedic Studies from the University of Tasmania (previously this was a Diploma in Clinical Practice (Paramedic) or similar, done by distance education via Charles Sturt university (I did this)).

Some Australian ambulance services are moving away from this style of recruitment. New recruits are now having to complete their tertiary education prior to being employed, which makes changing careers (like I did) much harder for mature aged people, who might have a family and a non flexible financial situation.

2) completing a Degree, Associate Degree or Diploma in the pre-hospital care field (available from a number of universities) and being hired as a "graduate student" and completing between 12 & 18 months on road.

3) being hired on as a qualified officer because you were a qualified officer in another state or country (and have the appropriate education qualifications and experience).


In Tasmanian we moved from Protocols to Clinical Practice Guidelines about 18 months ago. Thus the skill set of a Tassie Paramedic is:
(This is not a complete list, but you get the idea)

Basic life support skills and the further enhancement of:
Interpretation of basic ECG's, SpO2, BSL, Temperature
Manual defibrillation
IV canulation
Limited narcotic pain relief (max 10mg IV of Morphine for non cardiac pain (max of 20mg IMI if no IV access))
Drug therapy (sublingual, oral, IMI and limited IV) for:
Cardiac arrest - Adrenaline IV & fluid
Chest pain - GTN, Aspirin, O2
Musculoskeletal Pain - Entonox, Penthrane, Morphine
Asthma - Salbutamol, Atrovent, O2, Adrenaline IMI
COPD - Salbutamol, Atrovent, O2
Narcotic OD - Narcan IMI
Hypoglycaemia - Glucatol, Glucagon, Dextrose 50% IV
Anaphylaxis - Adrenaline IMI & fluid, Salbutamol
APO - GTN & IPPV
Seizures & Agitated Pt's - Midazolam IMI
SVT - Valsalva Manoeuvre
Fluid resuscitation for Trauma, Anaphylaxis, Hyperglycaemia,
Airway adjuncts - OPA, NPA, LMA, Laryngoscopy and Magill's forceps
Limited Paediatric Guidelines / Pharmacology


My next post will have the upgraded skills of an Intensive Care Paramedic.


Til then, be safe.

Advertising For New Staff

There were advertisements in today's local newspaper (Sat 13th June 09) and I suggest they were in the other 2 regional newspapers, for multiple statewide positions starting January and February 2010:

Student Ambulance Officers and
Student Ambulance Officers (Graduate)

Applications close Friday the 26th of June 2009

The Government Gazette will have them advertised this Wednesday.
Tasmanian Government Gazette

Til then, be safe.

My new Apple MacBook Pro...

I'm an Apple Computer user (since 1992) and the latest WWDC keynote address released details on the new laptops...
http://www.apple.com/au/macbookpro/

I'm going to upgrade my 5 year old Powerbook to a new 15" Macbook Pro, woo hoo.

I won't be getting it for a month or two, but I'm really excited (been planning the finance for months now).

In 5 years (for the same money) the specs have changed to:

Screen: 15.2" (1280 x 854) --> 15.4" (1440 x 900)
Processor: 1.5 GHz PPC G4 --> 2.8 GHz Intel Core 2 Duo
Video Card: (64 MB) --> (512 MB)
Bus Speed: 167 MHz --> 1066 Mhz
L2 Cache: 512 KB --> 3 MB
Std Ram: 512 Mb --> 4Gb
Max Ram: 2 GB --> 8 GB
Std HD: 80 GB --> 500 GB
Superdrive: 4x Single Layer --> 8 x Dual Layer
Airport: 802.11b/g --> 802.11n
Bluetooth: 1.1 --> 2.1 + EDR
FireWire: 800 & 400 --> 800 Only
USB: 2 x 2.0 --> Unchanged
Networking: Gigabit Ethernet --> Unchanged
Modem: Internal V92 --> None
No Camera --> Built in Camera
Battery: 50 Wh --> 73 Wh


And the 2nd revision of the iPhone is out in a couple of weeks.
I've held out long enough, (I was waiting for the new model), so I'm finally going to get one.

I need to work some more Overtime.

Til then, be safe.

Branch Station Officers

Well, I'm due to be back at the branch station this afternoon but something has come up with my family and I'm off work on carers leave, so I won't be going back to the branch station this block. My family comes first, as I'm sure it does for everyone else. (a wise Japanese sensei once said "family, work, sport, in that order")


Here is little more information about being a BSO (Branch Station Officer).
I have a more detailed overview post about the Tasmanian Ambulance Service, which I'll add a little later.

Tasmania currently has 13 stations where the salaried officers (BSO's) are supported by volunteer ambulance officers (VAO's). These stations are usually about 40 to 60+ kms from the larger city centres and thus service the smaller communities (populations of about 2000 - 5000) and then there are volunteer only stations that service the much smaller areas.
See this link for an idea...
http://www.tasmanianambulancevolunteers.asn.au/location.htm


Working at a branch station can be very financially rewarding for those that enjoy it and volunteer to become permanent BSO's or to those that put their hands up to relieve.

The extra cash comes from:
* the slightly higher pay rate you receive at a branch station
for working solo / with volunteers / training the VAO's
* on-call allowance
* the overtime earnt, by being called out
* living away from home allowance (for relieving officers)
* traveling allowance (for relieving officers)

The last 2 don't apply to officers who have chosen to become permanent BSO's, only to those that relieve in those positions.


Taking into account the extra money, it's not for everyone but some love it:
* You are away from home / your family for 96 hours straight.
* You are alone at the station unless you get a job
(permanent officers can pop home during the day and get to sleep at home, if they live in town).
* Your pager could go off at any time, (when you are in the shower).
* You don't have another qualified officer/student to bounce ideas off.
* But you are it, you make all the decisions.
* Quality back up is at least 20 minutes away.
* The work load is usually very light.


Til then, be safe.

I did it, it's over.

Went to hobart, 2 viva voce's. One in front of a Cardiologist and the other with an Anesthetist.

I am now one of Tasmania's newest Intensive Care Paramedics, woo hoo....

Til then, be safe

Goodbye for now

I've decided I'm currently not guaranteeing the privacy / confidentially of my patients due to wanting to post stuff straight away.

I didn't get any hard words put on me by management or anyone else, just an inquiring question from a fellow blogger who really made me think. I don't need any hassles from this hobby, so I'll focus on other things, like finishing my ICP course.

Hopefully I'll be back one day.
If and when I do start again, people will NOT be able to identify patients. I'll change more details and post weeks or months after the actual event.

Read the blogs I read on the right, they are great reading.

Til then, be safe