Showing posts with label Cath Lab. Show all posts
Showing posts with label Cath Lab. Show all posts

Thursday, 21 March 2013

Experience

"28 year old female, lacking experience....."

Right! Rant time! This post was inspired by a twitter conversation with @butwhymummywhy about being judged as being too young! (see her musing on the same subject here) Tell me, who here has been told they were too young to do something? Which mothers have faced criticism for being to young to have a baby? I'm not talking the 13 and 14 year olds, they ARE too young. I'm not even talking about the '16 and pregnant' ones. I'm talking those in the low 20's. At what age is the 'right age'? Who has not been trusted at work because of their age? Who's opinions have been discounted because they were 'too young' or 'inexperienced'? Personally, I've been on the receiving end of a number of comments about being 'too young' throughout my relatively short life. Being a parent at 23?! What was I thinking! Far too young! Right?! Let me put this too you....

Let's say I went to university, graduated at 21, got a job, worked for 4 years, had a committed relationship and then had a baby at 27. Is that acceptable? Yes it is! How about leaving school at 16, working for 3 years, buying my own house, had a committed relationship, worked for another 4 years and had a baby at 23. I was earning more than most of the 23 year olds with degrees. I owned a house and had 7 years working and living as an adult under my belt. Am I any less qualified? Apparently so! Surely my degree from the University of Life counts for something?! It really pisses me off when age is used to undermine, with nothing to back it up other than a date of birth. 

Now take the work place. My work place. The ambulance service is a very strange working environment. There is a bizarre mentality amongst many that the more years of service you have done, the better you are. There is a culture of looking after the 'long timers' and the 'newbies' can deal with it. The relief rota is a case in point. Working 7/10 weekends indefinitely just because you are new if fine for a few years but 3? 4? 5? 6 years? When are you experienced enough to not have to do the shifts that the experienced staff don't want to?!

"68 year old female, chest pain"

I was working with a guy who had done 25 years on ambulances. The shift had been painful. He didn't have the time of day for me because I was a student. At no point did he bother to ask where in my training I was. He opened the days conversation with 'are you one of jumped up Uni medics or one of the Playmobil Paras?'. There is a lot of ambiguity in the service about university students. They are seen as stuck up 'know it alls'. OK, some are but similarly there are 'old hands' or 'dinosaurs' who swagger around with just as much self importance. It's not the training, it's the personality. Difference is I wouldn't call them a derogatory name to their face! This guy was giving me one of two labels regardless of what kind of clinician I was. For the record I was a 'Playmobil Para'. I get this label because my route to becoming a paramedic had a different name for the final exam than what used to be done. Therefor it stands to reason that I will be incompetent, useless, untrustworthy, unknowledgeable and a clinical liability. Right?

The hours past with stories about 'back in the day' and instructions not to do too many jobs in the shift etc. I was mocked for being thorough and told my extensive paperwork was a waste of time. I ignored it. It was the expected treatment for a relatively new student. By relatively new, I mean only 2 years. At 4 shifts a week, 10 jobs a shift, that equates to roughly 4,160 patients. In that time I had done 2 ECG recognition courses, a course in Trauma, plenty of home study, clinical updates, reflective practice and some other work related stuff. Yes I was new, yes I was still keen (still am) and no I didn't tell him what I'd done in my spare time.

We arrived on scene at the patients house and as the 'newbie' I carried all the bags while he followed with his hands in his pockets. The patient looked like crap. Pale, sweating and complaining of central chest pain radiating to her jaw. I did the ECG, looked at it and KNEW it was heart attack. I passed it to my crew mate of 25 years experience.

"Nah, it's just high take off."

A) Normal B) Heart Attack (NOT High Take Off!)
For those not down with ECG terminology, we look for ST segment elevation. I know that means nothing to most of you but all you need to know is high take off and elevation can look similar but are not the same. I explained my reasons why it wasn't high take off and the response I got was:

"You can use all the long words you like, that's high take off."

The reason this was a sticking point was, if it WAS a heart attack, we would be travelling a long way to a Heart Attack Centre and would be late off. It is wasn't, and was just high take off, we'd be going to the nearest A & E and would be off on time. 

"I've been doing this job for 25 years, you're a student, trust me, it's high take off."

"It's elevation, we are going to the HAC, you can call clinical support if you like. The history matches the ECG."

He muttered something under his breath about 'know it alls' with 'no experience' and stomped off to the cab. We drove to the HAC, the waiting cardiologist looked at the ECG and confirmed it was indeed ST elevation and she was indeed having a heart attack. 

Student 1 - 0 25 Years Experience

It made for an awkward journey home. I didn't gloat. I didn't say 'I told you so' but I didn't need to. He just ignored me. The silence was golden. My point isn't that I was great. On a day to day basic his wealth of experience would help him and me in many ways but just because I'm young and new doesn't mean I don't know what I'm doing. He hadn't done any training for years, no continual professional development. Therefor, is 25 years experience just 1 years experience repeated 25 times? I have uppermost respect for people who have done the job for so long but respect still has to be earned. Treating my like an idiot only earned my crewmate disdain. I don't know everything, far far far from it. I'm still learning. I'll always still be learning. The time I don't feel the need to learn more is the time I stop gaining experience.

People should be judged on ability not experience. People should be judged on how how well their children are brought up, not how old the parents are. Experience is relative. It's well known that discriminating against sex, race, religion and sexuality is not acceptable in today's society. Well, age isn't a reason to belittle / dismiss / ignore someone either. To label someone as too young to do something or to have done something, smacks to me as criticism to justify their own choices in life. There is no point in having experience if you've done sod all with it.

Rant over! 

Do I have enough experience ranting to call myself a well rounded ranter or am I too young?

Thursday, 9 February 2012

The Ass in Assumption

"56 year old female, chest pain"

Chest pain is a funny old job. More often than not it is a LOB. Muscular chest pain, panic attacks, drugs, abdo pain, heartburn and indigestion. Obviously due to risk of heart attacks it is a very high priority call and rightly so. Cardiac care in London is of such a high level, if there is a chance it is a heart attack the sooner we are there the better. Survival rates are improving year on year and if it is a heart attack you will normally be on the table in the Cardiac Catheterisation Lab within an hour of phoning for an ambulance. This particular day had been a day full of rubbish. A collection on man-flu, vomiting and period pains. This job had 'potential' but we'd have to wait and see if it followed the calibre of the jobs thus far. We pulled up outside the house to see an FRU already there. The job was only 4 minutes old so he must have been round the corner. We went inside and were taken to the UPSTAIRS bedroom by the patients husband. 

The FRU was knelt down at the bedside, the patient was sat up in bed and to be honest looked like crap. Pale, sweating and in obvious discomfort. Unfortunately the guy on the car looked equally like crap but for different reasons. Hair was a mess, unshaved, shirt untucked, no epaulettes, creased, chewing gum and laces undone. Uniform is a pet hate of mine. We are a uniformed service and as such you represent your service and your colleagues when you wear it. The is no excuse to look as scruffy and unprofessional as he did. My crew mate had disappeared off to get the chair while I found out what had been going on. She had a sudden onset of pain 15 minutes ago in the centre of her chest, the pain was also in her jaw and left arm. She described it as a crushing pain.  The FRU took her pulse, blood pressure, temperature and BM and then said the following:

"Well, your OB's are fine, I'm pretty sure it's not your heart, grab your things together and come down to the ambulance"

He then looked at me and rolled his eyes. Was he for real?! Was he not seeing or hearing what I was?! She had a great cardiac story, she had risk factors (overweight, smoker, diabetic and hypertension), she was clammy, the pain was radiating and she had chest pain!!!

"It's OK, you stay there, my crew mate is getting a chair for you, we'll pop you down to the ambulance and do an ECG to have a look at your heart and then decide what to do. Is that OK?"

She agreed and looked rather relieved. That clearly pissed off the FRU but at this point I didn't care one iota. We got her down to the truck and wired her up to the Lifepack. As here initial rhythm came up on the screen the FRU chipped in again and said to the patient in a cocky tone and a wink:

"From here it looks alright, you'll be fine"

What an ass! About three seconds later the ECG printed out. Unsurprisingly she WAS having a heart attack. For those in the medical know it was a huge anterior MI with reciprocal changes and at least 12mm of elevation in V 1, 2 & 3. For those not in the medical know, it was a massive heart attack! The FRU sheepishly moved to the back of the truck whilst I explained to the patient and her husband what was happening and what was about to happen. A lot was about to happen very quickly, I was going to cannulate her, give her morphine, more GTN, blood pressures and ECG's galore on route, lights and sirens, a procedure in an operating room and all within the next half an hour. It is daunting but she took it in her stride and stayed calm. We put in a blue call to the cath lab (heart attack centre) and headed off. The FRU chose not to come with us........

We pulled up at the hospital and the back door swung open. The lead cardiologist was waiting to see the ECG. I passed them out to him and gave the handover whilst we were wheeling her into the hospital and to the lab. We transferred her to the table and left her with a swarm of Dr's and nurses prepping her for the procedure. We sat in the viewing gallery and watched. 20 minutes later the cardiologist came out with a petri-dish in his hand. In the dish was the clot that caused the heart attack. It was tiny! Our patient was now pain free and her ECG was normal and would make a full recovery, albeit on medication for life. Amazing! The joys of modern medicine.

This was a great job and highlighted a number of things good and bad. Firstly, call 999 for chest pain. If it IS a heart attack you will get the best treatment in the world and quickly. If you look at the times on this job, you can see why survival rates are so high.

Onset:                  21:50
Call connect:        21:58
Dispatch:              21:59                   *Balloon is the term for when a stent is in-situ
On scene:             22:03                     and the coronary blockage is cleared.
To hospital:          22:21
At hospital:           22:29
Balloon*:              22:55

Onset to Balloon:    1 hour and 5 minutes

Secondly, never, never, never, tell a patient they are fine when they clearly are not and never say "It's not your heart" when it clearly is. Don't commit to a diagnosis and don't mislead or lie to a patient. You get caught out will look like an ass. Finally if you have a uniform wear it properly and if you have an attitude, loose it.  It makes you look like an ass. I can't stand these people, luckily they are rare but they are ones who get the complaints and their image is reflected onto all of us. If you have the job and hate your patients leave. Rant over! x