Scott’s Spiel

Quite rare, but they do happen.

Just yesterday, when I talked to my mum and decided not to work at all over Easter and instead face financial mayhem, do I hear about an interview for a phlebotomy job. Considering I’ve applied for that about 3 times in the past, it’s progress. It’s next Wednesday and I just so happen to be free that day. Call it fate. We’ll see.

Even more impressive was my mum taking me to see cars and end up buying one. Sadly it’s not for me but I was still amazed at the abruptness of her decision.

Pain management is rolling along nicely. We have only one more clinical day outstanding and it’s paediatrics, which should be excellent. I have so far this SSM seen - people in pain, gynae day surgery, more people in pain, impressive surgery involving blood with colourful stuff in it, difficult intubations and difficult sedated patients, 2 caesarian sections (both girls, all well), fractured femurs and difficult hips, knee replacements and acupuncture. Quite a lot for 2 weeks! It’s been an excellent module and now I have to start thinking more about the report. I’ll probably stick with PCA as it’s quite a wide topic. Not sure if I’ll get it buffed up to the size required for the essay competition - it’s possible.

We have a tutorial tomorrow to discuss it with our supervisor so I’ll see what’s mentioned then. Following that I have what can only be described as a weekend of first aid - kids hockey, adults boxing (both Friday), Saturday football and helping out at a first aid class on Sunday. I didn’t quite plan it to happen like that, but if phlebotomy goes forward I may not have many free weekends left!

Personally, I would say the internet is one of the most important mediums these days. Access is almost national and an organisation that didn’t have a web site would probably look rather silly. I’m sure most people would agree with me so far.

I wish St Andrew’s would.

The main site is pretty decent, a few technical errors but the content is good and pretty up to date. It provides a reasonably welcoming approach to volunteering and details of where people can go to find out more.

If you move from here onto the Glasgow Executive site then already the colours have changed, layout is different and personally it just doesn’t look as good. However, you’re going to have difficulties getting there anyway as the main page does not link to the Exec one. This sublevel is also not quite as up to date and certainly doesn’t have a very welcoming spiel for potential volunteers.

If we go even deeper into the actual company level, you’ll only find a few with proper web sites. Even then there are those with web sites and they have no incoming links. At this stage the layout resembles nothing of the main page and could be way out of date. The majority of them have no attraction for potential volunteers save perhaps an email address.

Ideally there should be some uniformity. I’d also like to see the same colours preserved across the sites, making it obvious that they’re all St Andrew’s. Further, there should be a contact form, as well as an email address, for potential volunteers. Further things such as calendars (which need to be up to date or are pointless) and pictures do nothing but add depth and hopefully spark interest.

I feel that St Andrew’s is very much an “old man’s” company. It’s resisting change as much as possible by sticking to phone numbers and sparse web sites (amongst other things). If it was to modernise just a little bit, it may bring in younger members who’re more enthusiastic about doing duties.

I really like the Grampian site - it looks by a large a lot more professional than the others and yet isn’t difficult to use. It’s also up to date (ish) and has a generally inviting feel (you can disagree with me if you like).

However my favourite so far has to go the Durham LINKS site. It’s a St John’s page so I’m slightly cheating a bit but to me it’s using the net to its best.

I have volunteered to help my company with the website but I’ve got no response. Maybe that’s a good thing as I’d be overly tempted to turn it into more than it probably should be. Then again, since our latest member found us on the web (though not the company site) maybe I’ve got a decent point?

You’re covering First Aid at an event when a member of staff from another, nearby, event asks you to look at someone from the other event.

However, they’re not paying for First Aid cover.

Do you decline, or agree to have a look?

Don’t really want to add any more specifics than that, although I know my answer would start with “It depends…”

So I got to up my St Andrew’s experience this week by going to my largest event so far at the Rangers vs. Hearts CIS semi-final. The turnout as far as crowd’s concerned was 31000, give or take. To compensate we had 14 first aiders, 4 of which have to be available on the sidelines to staff the scoop stretcher. Another couple were in the first aid room and 2 were duty officers. This gives about 6 to actually staff the crowd. I got the impression, and well it was kind of obvious, that this was a bit few.

The thing I’m not sure about is why. For me to get there I had to do a bit of persevering but if they’re that desperate then I shouldn’t need to. There’s talk about us maybe losing the contract to do the football. I can’t really see that happening because there isn’t really anyone else to do it. Anything is possible though, I guess.

The actual event was pretty good, and a fair bit different from a Queen’s Park game. I had a good conversation with the other first aider I was on with and she filled me in on a lot of basics which I had kind of gathered by now myself. I was just below a bulk of Hearts fans, who were understandably disappointed, but loved making quite comments about the ridiculous hats we have to wear. I understand that there might be some things thrown at us that wouldn’t be comforting were they to hit us on the head. That said, neither the ambulance staff, security staff or stewards have anything of the sort. A bit excessive if you ask me.

I did, however, get a kit bag! It’s one of the old ones but damn it’s better than nothing. Now all I need is a little bit free cash to stock it properly. Phlebotomy anyone? It’s worth (another) shot I think. Maybe.

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.

—-
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...]

December already, it’s been such a quick year. This means I now have to accept that Christmas is near and should probably make more of an effort on the present front. It also means I have to open my two advent calendars (neither of which I bought!). Guess I’m going to be taking my running stuff home with me…

Now that I’ve actually spent some proper time with St Andrews I get an understanding of the real disadvantage that must plague ambulance staff. Whilst we can do a lot for things like cuts and stuff, we never really know what happens to people afterwards. Take a suspected fracture. Did the guy go to A&E and get it seen to? Was it even a fracture? Will he be playing this weekend? I don’t know whether it’s medical curiosity or just general need-to-know that makes this bug me. Kind of makes me wonder whether I could deal with working in A&E or not.

At the end of the day though, I don’t have any choice but to move on. The more serious the casualty though, the more I want to know.

In other news, I only have 1 more day to go! This is followed however by 2, maybe 3, nights out. I’m having a real problem enjoying nights out this year. I don’t know whether I’m just bored of people there or if I don’t see the point in getting quite so drunk quite so often. Who knows, but I feel compelled to go anyway.

Block 8 coursework was handed in on Tuesday. I wasn’t ecstatic that it was my best work but I feel it was a pass at least. We get our Block 7 results this Friday, which will either put me in a good or bad mood for the rest of the holidays. Oh the fun.

So this is what my eyes currently look like. It’s not the greatest photo but I think you can still clearly see the difference in pupil size. Something like this would probably be taken as a sign of some quite bad problems in a patient. Thankfully however, this was brought on by the wonderful actions of tropicamide (0.5% - an antimuscarinic for all those that care).

Basically the point of lab this morning (possibly the best in a while) was to get us to use ophthalmoscope for the first time. This involved making everyone having one very dilated eye and the other with which to examine someone else’s very dilated eye. I now want an ophthalmoscope, purely because it’s the best thing I’ve used since a tendon hammer. Unfortunately they start at £80 so probably not until I actually need it.

The downside of one dilated eye and one responsive is that reading/writing or anything involving near vision (the pupils should contract for near vision but the tropicamide paralyses the ciliary muscles responsible for this) was quite blurred and is only now coming back (2-3 hours later).

I’ve also finished my coursework (rejoice!) which was all about monoamines (again, for those who care). This means I can probably go to the rugby tomorrow as well as Hampden, providing I get my uniform and kit bag today.

Finally got the chance to look over my communication skills video of my interviewing an angry mother (actually an actor). Basically, the story went that she’d discovered that her (15 year old) daughter had been prescribed the Pill. Rather than talking to her daughter about all this she stormed down to her GPs to find out what the hell the doc though he was doing, contraceptions of all things - “I mean she’s only 15!”.

Out of the 5 actors I could’ve picked that day, this was probably the worst. However, being the model student I am I’ve decided to learn from this event. Here follows my rules (in no particular order) for dealing with angry mothers with Pill-taking 15 year old daughters:

1. Apologise. They like that. Something such as “I’m sorry to see you’re upset about this”.
2. Be careful with confidentiality. Can’t even tell them whether their daughter attended the practice or not.
3. Never ever interrupt the ranting mother. If they really want to talk for minutes on end, let them. Follow by #1.
4. Explain, in general terms (watch #2) things like Gillick competence. The criteria for prescribing contraception to those under age (aka Fraser guidelines) are:
   1. the young person will understand the professional’s advice;
   2. the young person cannot be persuaded to inform their parents;
   3. the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment;
   4. unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer;
   5. the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.

   Tell the mother these. First, make sure you know them (which I didn’t).

5. Don’t ask pointless questions about the mother.
6. Don’t accuse her of not being available to her daughter.
7. Don’t smile or laugh. Seriously, that’s a big no no.
8. Try not to think of the 8 people watching on camera who will probably be in fits of laughter. Should help with #7.
9. Do try and find out about the kind of mother/daughter relationship.
10. Do let her speak to the doctor at some point. She probably isn’t chuffed to be lumped with a medical student. Try not to take too long about this. The quicker you finish, the quicker she’s shouting at someone else.
11. If possible, try and get her to not shout at you or someone else.
12. Even better, try and get her to avoid throwing her handbag at you. All physical contact is something to avoid. Thankfully, actors aren’t likely to take a swing at students, even in Glasgow.
13. <more?>

I can feel the CPD (“holistic commitment to structured skills enhancement and personal or professional competence”) people idolising this post.

Hopefully I’ll do a better job when it’s not an actor.