Sean: As placement beckons…

Seán FlynnBeing a first year Paramedic Science student sometimes has an air of make-believe about it. We dress proudly in uniform for skills classes but we are by and large untested. And sometimes – particularly now, just ahead of placement – the restlessness this generates is practically palpable.

Don’t get me wrong; the scenarios we play out in the skills labs mightn’t exactly be Shakespearean tragedies – they’re usually just ordinary human tragedies but they’re no less gripping for all that. In these urgent clinical dramas, it’s a bit like method acting; the more you commit to your role, the more you tend to learn.

But until we get out on placement, this all seems a little theoretical; at least for those of us who don’t yet have that kind of clinical experience. It’s all been leading up to this and now, after time sometimes seeming to drag, the hour of placement is suddenly almost upon us.

A Monday morning briefing on 20 February for those going with the London Ambulance Service (LAS) brought quite a few issues into sharper focus. The Link Tutor with the LAS, gave us the lay of the land about working life in London town. He didn’t glamorise it and why would he? He did however make us aware of the kind of support services that are available to us in the event of having to deal with any particularly difficult experiences.

Aside from the near certainty of bearing witness to great sadness on a daily basis, the reality of pulling 12-hour shifts and then driving two hours home is beginning to sink in. For body or soul, this won’t be an easy gig by any stretch. And it sure isn’t for the love of money.

As a taster of what might be expected when we do get out on the road, the recent experience of one of our cohort as he made his way home from university is salutary. Having found himself first on the scene of a road traffic collision (RTC), he remained there with his patient until HEMS (Helicopter Emergency Medical Service) arrived. Suffice to say, our classmate’s conduct was extremely professional.

That story is curt, abrupt even, almost like a military despatch but for good reason. Firstly, it needs no dramatisation but more importantly, from a practice point of view; in the interest of anonymity, more granular detail might lead to identification and a breach of patient confidentiality.

But in his actions, I reckon our quick-thinking colleague did what we would all hope to do in a similar situation. The same man would modestly tell you that he only did what he was trained to do and in a way, he’d be right; even if he’s still owed serious kudos for his cool-headedness.

At some point before long, many of us will find ourselves in similar or perhaps even more challenging situations. I wish I had advice to offer but like most of my cohorts, I remain untested and I’m just going to have to trust to my training and the wisdom of my mentor (though not necessarily in that order). All I can do is wish us all well and if it does get hairy, that we’d avail of the appropriate services and (perhaps even more importantly) avail of each other’s support.

So hopefully, in a few months we’ll all be swapping wagon tales like old hands. And in among the black humour and bravado, there’ll be clinical nuggets and I daresay a deeper understanding of the human tragedies we play out in the dressing-up box.

Alex: Returning to university

I have come back to normal university lectures and skills sessions after a successful placement in central London. There’s always post-placement blues as the reality of the course settles in with essays and deadlines here and there. However, a new year means a few steps closer to becoming a registered paramedic and, in fact, I will hopefully be graduating next year.

In January, I submitted an applied anatomy and physiology essay that was 4,500 words, which certainly took a long time to write and reference! I’m glad to say I received a good mark for it and one of the senior lecturers even rang me on a Saturday to talk through the marking! It’s gestures such as this that remind me why I’m studying at Anglia Ruskin University. As well as what seems like essay after essay, we have been learning about Advanced Life Support (ALS) and pharmacology (the study of the effects of drugs in the body) in our practical skills sessions. These have been going really well and we alternate between each other, to take the leadership role in ALS cardiac arrest scenarios in simulated environments on campus.

Alongside my studies at ARU, I have thoroughly been involved in the charitable operations at London’s Air Ambulance, where I volunteer as a photographer and speaker. I have worked for the charity since I started my Paramedic Science degree and just in the last few weeks I have led three evening talks for institutes across London, including the London Freemasons in the City. The London Freemasons have donated a staggering £2 million towards the purchase of a second helicopter (call sign G-LNDN). It was a privilege to stand in front of the head of the Freemasons, but all the more nerve-racking! I am pleased to say that once my presentation was finished they presented myself (representing London’s Air Ambulance) with a £500 cheque for the charity. It’s for this reason why I chose to volunteer in the first place, as every donation really does count.

Alex: End of placement

On a sunny winter’s day in the borough of Brent, a paramedic and myself set about our shift in one of the service’s new Tiguan Fast Response Units (FRU). It was put through its paces as we responded to multiple general broadcasts (GB) throughout the day. One GB was to a drowning in progress at a reservoir where NPAS (National Police Aviation Service)were circling above, and LAS (London Ambulance Service) HART (Hazard Area Response Team) were in attendance alongside the Met Police marine unit. Thankfully the call wasn’t as given: the male psychiatric patient had only been wading through the water and was not submerged. We had to trek 200m along a muddy forest trail to get to the patient, and with the Lifepack 15 and O2 bag it presented as tiring work!

The following two shifts, later in the week, brought me back to familiar territory working on a FRU out of Camden with an Australian paramedic. Since the cars are held back for Red 1’s and Red 2’s primarily we had a lot of green time; meaning we could drive around the West End, visit Big Ben and even be on standby in front of Buckingham Palace! Our car number plate was coincidently ‘CVA’, in which we attended three Cerebral Vascular Accident’s (Strokes) just in one shift, alongside a patient with a Pulmonary Embolism (PE) and others that had fainted at work.

The last three shifts of placement were back with my regular crew on an ambulance out of Islington station for a set of lates (4pm-2am). Friday night proved to be very busy starting off with a young boy who fell off a trampoline at a friend’s house. On arrival it was pitch-black darkness, so scene management was initially difficult until the family kindly held up their phone lights for us. The patient had a severely deformed left arm, which we suspected the injuries to be a dislocated elbow and fractured distal humorous. His pain was well managed with Paracetamol and Entonox and had good neurovascular state distal to the point of injury whilst on scene. However, once splinted and treated, he started complaining of numbness in his affected arm en route to hospital. We exposed the limb to inspect once more to find he was significantly cold to touch distal to the point of injury: a worrying sign of vascular compromise.

At this point we were pulling up to A&E, so we proceeded to wheel the patient in on the trolley bed and called over a senior consultant to give an initial triage. His attention was drawn into the affected limb where he could not find a radial pulse. He instructed us to get back into the ambulance and undertake a critical transfer to the next hospital that specialised in paediatric orthopaedics. Whilst all this was happening around him, our patient was in good spirits talking about all his favourite action figures, probably due to the Entonox…

Following on from that job we greened up at hospital where we instantly got dispatched to a Red 1 just around the corner. Our MDT screen displayed: “29YOM, UNCONSCIOUS, RTC cyclist off bike, blood coming from mouth”. A message popped down to us to say ‘please advice for further assistance on arrival’ which gave the impression we may be on our own here. We arrived to find multiple bystanders surrounding the patient who was wearing many layers of protective cycle clothing, a helmet and a big backpack. He was lying prone on the road, responding to voice and had lots of blood on his face. After conducting the primary survey I held his head whilst my crew prepared the orthopaedic scoop stretcher and trolley bed. He was in no pain but was very confused; constantly asking me what had happened every minute, scoring a GCS of 14 (4,4,6).

Once in the ambulance away from the bystanders we appropriately exposed the patient by cutting off his clothes to assess for any injuries we may have missed. He had bilateral chest rise, globally clear air entry and no pain on palpation of the pelvis and long bones. We decided to convey to the nearest Major Trauma Centre (MTC) that was only a few minutes away from the scene. Once in Resus, I gave the handover to a HEMS doctor, as my crew lifted the patient from our trolley bed to the hospital bed. The consultant had no questions after my handover, which is always a good sign that I included everything necessary and relevant! It was the first major trauma patient I had taken the lead on and I am so happy with how I managed the patient, especially with our on scene time being just 29 minutes!

So that ends placement block one for second year of the BSc Paramedic Science degree. When I am back after the Christmas break we will be studying pharmacology in lectures and have our placements on various hospital wards.

Thank you for reading my blogs up to this point and I hope you have a good new year!

Alex: Too old to die young

This week has undoubtedly been a challenging one on placement with the London Ambulance Service. Alongside many blue calls and time-critical patients we have responded to some very thought-provoking jobs.

A 999 call was made at the start of the week stating a water pipe had burst from underneath the road, causing severe flooding to the surrounding streets. On arrival, there were at least 11+ fire and rescue pumps, two London Fire Brigade command support vehicles and dozens of police cars. A senior police officer gave my crew and me a brief introduction to the scene, which was in Angel, North London. He stated many people had been evacuated to a nearby pub for warmth and shelter as the on scene emergency service workers battle to stop the flow of water. Our Hazardous Area Response Team (HART) followed us into the pub ready to triage any potential patients. When we got there, though, there were no patients at all, just a lot of damp shoes and socks! The Metropolitan Police declared it a major incident so we stayed on scene, with HART, until the Incident Response Officer (IRO) stood us down three hours later.

A whole five minutes after greening up in Angel, the alarm sounded on our Mobile Data Terminal (MDT), which displayed RED1 Cardiac Arrest, was on going just around the corner. With no hesitation we made our way to the address and arrived at the same time as a FRU (Fast Response Units). I entered the property first, but struggled to find anyone inside. My mentor heard noises coming from the kitchen, which was hidden around the corner of the living room. It was an incredibly small space, and she discovered the stepbrother performing CPR on the patient. Unfortunately we found the patient to have rigor mortis; there was nothing we could do for them.

We acquired the 30-second rhythm strip, which showed the patient to be in asystole and declared ROLE (Recognition Of Life Extinct). He was so hypothermic our tympanic thermometer read ‘LOW’ instead of a number, and he had fixed and dilated pupils. His death was completely unexpected, and he only had one common medical condition, which was well controlled by medication. The police were in attendance as standard procedure. It was a heart-breaking situation to be in and we consoled the stepbrother as he began informing the rest of the family. Soon to arrive was the brother of the deceased. We had to tell him that his brother, who was just 29 years old*, had passed away unexpectedly. His reaction was horribly upsetting, and he asked to see the body, to which we said yes. I went into the room with him so he could say his goodbyes. His breakdown and the sound of his cries will stay with me for the rest of my career.

This was a terrible start to the week, but we carried on with the shifts as normal and proceeded to attend an Inferior Segment Elevation Myocardial Infarction (STEMI) as our next job. We followed protocol and blued him into the nearest Cath Lab, which was St Bart’s Hospital in the City. Thankfully the cardiologists deemed her not table worthy, but instead admitted her to the ward for close observation and investigation. The next few days brought us an array of patients including a lady who fell down the stairs and sustained a head injury. I managed to cannulate her and my mentor gave Ondansatron and Paracetamol as treatment.

Sometimes on placement we go to jobs that can be daunting, horrible and emotionally straining, but it’s part of the career I’m going into. This is the reality we live and work in. The brother of the deceased 29 year old* said to me on the balcony of the block of flats: “I guess this is the s*** part of the job you have to deal with?” I was near enough speechless, as I couldn’t begin to imagine what he was going through, but yet he recognised the work we had done and thanked us for our attendance. Not many 19-year-olds have told a family they will never see their brother, stepbrother, son, friend and nephew again. It’s the small things that count in this line of work and it’s the people you meet with genuine gratitude that give you the energy to keep going.

*Not actual age of patient.

Nina: Modules in semester 1 (aka ‘Why am I learning this?’)

After I explained my journey to university in previous blogs, I now want to focus some more on the actual Applied Nutritional Science course.

The first semester consists of three modules. When I got told what they are, I actually felt like double-checking if that was a mix-up in some sort of way. In the beginning it made no sense to me why I had to do those modules! But now, a year later, I can see that to be able to study nutrition and the ways diet influences health and wellbeing, I needed a base. This is provided in the three modules in Semester 1: Scientific Communication and Laboratory Skills, Anatomy and Physiology of the Human Body, and Cellular and Molecular Medicine. As you can see, it all sounds very broad and the word ‘nutrition’ was missing to me.

But all three subjects have a purpose. To understand the influence food can have on the body, it is extremely important to understand the way the body is built as well as all the body systems.

Cellular and Molecular Medicine consisted of really interesting sessions in the lab where we studied diseased body tissues in comparison to healthy body tissues. It is great to understand the nutrition side of things but, in my eyes, equally as important to understand what effects diseases have in the body and how tissues change – for example due to liver cirrhosis, which can be very closely connected to someone’s diet.

In Scientific Communication and Laboratory Skills, all the basics of being in a lab were taught. Of course, you can go to a lab and do what someone tells you to do. But not everyone would be too sure what an Erlenmeyer flask was; and I personally had no clue about different levels of laboratories.

The lesson to learn from this is that the course is designed in a certain way and that a lot of clever people were involved in its planning. Sometimes we just have to trust them and it tends to make sense in the end!

Nina: How to: the first exam (aka ‘Maybe sleeping with it under my pillow does work’)

After the topic of assignments, the first exam cannot miss! Luckily, my first exam was fairly easy-going and before Christmas. I am still grateful for that because I do not want to revise while eating Christmas dinner.

Exams are scary. That’s it. They feel even worse than assignments, because you have to get all the information into your head, and suddenly nothing makes sense any more. After revising for hours upon hours, most of us give up and just hope for the best. But that should not be the case. Again, breaks are important. Do not try to work eight hours without breaks. I think one of the best things to do when your head is full, is going for a walk or doing some exercise. Just go outside and stop thinking about anything related to uni. Grab food with a friend or do some shopping. And then go back to your work. A clear mind works wonders because suddenly things get clearer and start making sense again.

There is no need to know every single word of your notes off by heart. It is about understanding principles and connections. A lot of processes in the body work similarly, so try and understand all the stuff behind it. Depending on what type of exam it is, try to write practice questions together with friends and swap them. Practising to answer questions will show any problems you might still have and is great for revision. If your lecturer does a mock exam or mock tests with you, try and prepare for these as they might be an indication for what grade you can expect. Also, they give you the insight in the style of questions they will ask you. Do not hesitate to ask course mates or your lecturer for help if something does not make sense. Chances are, other people are also struggling with it so you can try to work it out together. No one is going to make fun of you for asking a question, and even though a session with your lecturer might seem scary, that is part of their job and usually they are great for giving you advice about your work.

The main point is: believe in yourself. Sometimes giving up seems so easy, but that will not give you anything in the end. Just work hard, but do not forget to live and socialise in between!

Nina: How to: assignments (aka ‘Hopefully my laptop is waterproof as I am crying again’)

Hey guys, welcome back to my blog! Last time I tried to help you all a little bit with planning your work throughout the semester. At some point, the assignments will creep up and I was extremely worried to see that one 3,000-word assignment is deciding if I pass in some modules!

The key for assignments is basically the same: have a plan. Or maybe a few, as you will most likely end up deleting paragraphs of your work because you cannot find references…we all know the struggle. But really, you will be told early on in the semester about all your deadlines and the assignments you have to write. Do not wait until Week 8 to look at them, because then you will already be too far behind to do your work properly.

From my own experience, it is really helpful to start researching straightaway, just so you get a feel for the topic and the books and journals out there. It is great to use websites for research, but try to avoid them as references as they are just not scientific work in most cases (especially Wikipedia!). I know it is horrible, especially when you feel homesick and Christmas is coming up, but you invest a lot in uni and it is your future, so stay focused. Unless you are baking gingerbread men – then go on!

In my eyes, doing something daily is great, because it will not build up to a horrendous amount you cannot cope with. Also, your set-up to do work is super important. If you are someone who loves everything tidy, then take the time before working to clean your room. That is not procrastinating, but something necessary for you.

My perfect set-up is the following:

  • a cup of tea/coffee, whichever flavour is your favourite
  • a big bottle of water
  • adequate lighting
  • comfy clothing (writing an assignment in PJs is perfectly acceptable!)
  • snacks around you, but try to go for something healthy
  • a good study playlist (thanks Spotify for interrupting it with loud annoying adverts…)
  • my phone safely put away, as it is too distracting
  • tissues, because the tears will eventually come!

Hopefully some of this will work for you and keep you focused. Don’t forget, we are all in this together and every single one of us gets stressed about work. Just have a countdown to when you have to hand your work in, and be finished a few days early so you have enough time to check your work!