Scott's Spiel

Maybe I’m just a trauma buff (which sounds horribly morbid and quite unwelcoming, I agree) but I would expect most 2nd year medics to know what is meant by intubation. Apparently not, as I found out the other day when a friend was stumped by the word, apparently taking it to be a typo of incubate.

I don’t know about anyone else, but I’d rather not be incubated when I needed intubated!

This might seem like a simple slip up and I was quick to correct him. However, it highlights a much more worrying aspect of our acute clinical knowledge.

I’d maybe be extending my ego slightly but I feel that if someone were to collapse in the middle of Morrisons (or wherever) I’d be able to assess them, assist them and maybe even take a stab at a possible differential. Ignoring the last, how many of my colleagues would be able to do so, competently if not confidently? Probably not very many and I know a few that would panic.

I feel there is a general lack of very basic acute training in the course (at least, so far). We’ve had 30 minutes, at a push, of CPR in year 1. This is examinable in our year 2 OSCE (which makes a lot of people worried!) but other than that we’ll receive nothing more till our final year when we are expected to deal with Advanced Life Support.

There is a course, Immediate Life Support, run in conjunction with the UK Resuscitation Council – which I’m trying (with minimal success) to get on – that provides an intermediate between BLS and ALS.

This, or something similar, should be taught to junior medical students at some point. Not only would it possibly save someone’s life but would also mean the medical student who’s always telling first aiders on duty what to do, actually has a clue of what they should be doing.

The beauty of it all is that whether I get to sit this course or not is completely irrelevant by St Andrew’s. They (unlike BRC) don’t recognise external courses and still wouldn’t let me take an AED course until I’d been a member for a year.

This then begs the question: if a situation arose where I was faced with using a defib or not, understanding the potential benefits and unlikely consequences, would I do so?

Honestly, I just don’t know. But if St Andrew’s aren’t happy to use me, I’m sure BRC would be!

Disclaimer – This is not meant to offend anyone and should not be taken as such. It is simply observations I’m making about my first 2-3 months as a member. My views my change over time or I may end up correcting some of these myself in the future (who knows?). I do enjoy it, regardless of what’s here

Around the start of November in my 1st year (06) I finally discovered the existence of the voluntary first aid societies (applicable to me were the British Red Cross (BRC) and St Andrews Ambulance Association (StAAA)). I’ve still got my initial email enquiries to firstly StAAA HQ trying to sell myself to them and desperate for further information. After a while (over a month of getting sent from HQ -> Exec -> Company) I got an offer to come to some room in Caledonia University on a Monday night. By this point I was home or going home for Christmas so I didn’t go. I’m a pretty shy person and was really looking for information, not being invited to some strange place.

In the end I tried the Red Cross. They scared me asking for references, birth certificates and more for an interview (in some far away location) by the end of a week. I apologies, explained the difficulties, and left it at that. March became August before I got round to trying to find out more. This was a combination of exam and summer holidays, but I wish I’d got my finger out earlier, I really do.

I got another invitation to come to some night. I didn’t want to do this, I wanted to know more first. The same people giving my the invitation were holding a public first aid class for 4 Sundays which I would finish just before going back for 2nd year. After a few more emails and cheque problems I got on the course and met some pretty decent people. I was still terrified going into the first class but the difference here was a hotel in the middle of the city and I knew the area reasonably well, instead of a office in the south of Glasgow or a Uni towards the north(ish).

After the 4 weeks I probed into joining the company. I’d already met a number of the members (though I knew it not) and all I had to do was get a Disclosure and some references….simple! The Disclosure was a major cock-up. I handed it in at the start of September and finally got in back in November, only because I phoned and found out it hadn’t been received. It was well over a year now than when I first contacted someone to volunteer before being considered a member.

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My aim here was to show the very negative impression I got out of these people. Why should volunteering be a chore for the potential volunteer? If I’d been given a standard reply to my enquiry providing my with information potential recruits would need, such as:

• What volunteering would required
• The structure of StAAA
• The contacts of exec’s and companies (which is available in the members section of the website, for some confusing reason)
• A general welcoming reply, without being ignored for a month in an email inbox

This would be a short document, kept accessible publicly on their website. How many potential volunteers are lost because of lack of information or by not being as persevering as myself?

But that’s all in the past. I’m here now. Boy, was my selling myself not required.

Being honest, and polite, I can only call what I’ve seen and heard so far as a bureaucratic mess. At the shop floor level things are pretty dandy – we attend, we treat, we leave. The problem comes higher up. A sample of problems:

• After ~3 months of being a fully Disclosed, uniformed member I still have no equipment or bag. I would buy my own but it needs to match everyone else’s. I’ve bought my own belt, cool packs, torch, face mask, gloves, etc but can’t do anything as I’ve nowhere to put them.
• I was never, ever, properly told about who does what in the company. What I know stems from the website and StAAA regulations (which I haven’t been given, found them in the lost pages of another company).
• Company training nights very rarely involve any training.
• There is a general attitude that you can’t “fail” at First Aid. I disagree. If you can’t perform basic clinical tasks you should not be allowed on duty.
• Things are far too hidden and secret, both at a company, exec and national level. Council meets regularly (I can now see dates!). Surely these meetings are recorded as minutes? Why aren’t they available? There is a distinct lack of any communication from above the company tier. Arguments at a company level are unresolved, left to brew until they spill over into public view.
• I only just got access to the member pages in the last 2 weeks. It takes that long to come up with an ID number and badge?
• I want someone please to show me how to claim expenses…
• I want someone please to tell me radio protocol (although I’ve read all about it in the regulations…which I don’t have)
• I want someone please to explain why I need to be a member for a year before being put on a training course for a machine designed for people without training.
• I want someone (please?) to show me how to put someone on a scoop.
• I want to feel as confident as people seem to think I am when I go on duty.

At lot of this could be addressed by having 2 or 3 of the training nights separating new members and running through a quick session. Nothing explicitly formal but things that are relevant and not included in a standard first aid course. We get new members all the time (about 3 since I’ve been in, most following a public class). This could be developed into a small handbook available for them to read. I may even prepare my own if I see new members struggling to work out what’s going on.

I have other, wider concerns about fitness for members on a duty. I won’t lengthen this post any longer by putting them in here so they’ll be later.

I have no idea if anyone interested will ever find this post, but that’s not really the point. If you do though and are wondering whether to join StAAA/BRC or have joined and are major confused, please feel free to contact me (up to date email address on about page). I won’t bite and might be able to answer some questions.

Above all I do enjoy the work, however much the above might not suggest it.

So it’s almost the end of another year. It also means I’ve had a blog for about 8 months. I’ve not wrote as much as I’d have liked but, looking back, I’ve done not bad. No idea who is or why anyone is reading this but I hope it’s at least vaguely interesting.

Christmas was pretty good. My brother got a Wii, which is slightly shared with me, so that dominated most of Christmas Day and a good deal of Boxing Day too. Went to the sales on the morning of Boxing Day but couldn’t find much that interested me. Still managed to spend a bit on clothes. My other vouchers will go on stuff for my bike most likely which I think I’m taking back with me to Glasgow

After Boxing Day I went back to Glasgow to do some St Andrew’s work on the Ice at George Square. I managed, somehow, to get the wrong day – I went on the 27th and wasn’t meant to be doing anything till the 28th. So I went and bought a copy of Runner’s World (in an attempt to motivate me, not sure if it’ll work) and also another paramedic blog book and went back to my (rather empty) flat.

The day later I was back on the ice proper, although the weather was terribly and we were some of the few. I met 2 British Red Cross members who were on with us and learned a lot of interesting details about the differences between StAA and BRC. It’s not really too relevant to me since, at the end of the day (hopefully), I’ll be a fully fledged doc. However for those looking to maybe go into the ambulance service, the training provided by the Red Cross is far beyond any offered by StAA and within about a year they’ll be almost training to the level of an EMT.

Some of the differences are common sense (anaphylaxis is integrated into the standard first aid), others seem to cut down the red tap – I wouldn’t have to be a member for a year to take an AED training course – and then there is the general higher training level, involving medical gases and transport to hospitals.

I’m not really in the mood to convert over – not yet anyway – but had I known any of this before joining StAA I may have been tempted the other way.

Anyway, the event itself was dead. We had only a couple simple casualties. I did, however, get asked to come back the day later. Unfortunately there was relatively little for us to do that day as well, despite the much increased number of people on the ice. I did marvel at the insistence of one mother who wasn’t having any of her son’s injured knee and made him walk home. Mother’s know best, apparently.

I could be at the castle for hogmanay, thankfully not doing any first aid. See you in 2008!

[Posted a bit late, but I did write it in 2007...]