End of placement

Alex Grant

Faculty: Medical Science
Course: BSc (Hons) Paramedic Science
Category: Allied and public health

23 December 2016

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!
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