Emergency Interview - Ambulance Victoria

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Paramedic and Senior Team Manager, Danielle North, reflects on the changes in her profession and what it’s like to work in this dynamic and critical sector.

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What inspired you to pursue this career path?
I was always interested in being a paramedic, although I hadn’t given it a lot of thought until an incident in which I was required to call an ambulance for a friend. The crew that attended were excellent, calm and professional. In observing them and their demeanour, I thought this might be a possible career option. With some further research around the inherent requirements and demands of the role, I decided becoming a paramedic was likely the career path for me.
Can you give me a run-down of an average shift?
The shift length varies from 8 to 14 hours, with most paramedics working a combination of day, afternoon and night shifts. The most interesting part of being a paramedic is the variety, and not really knowing what the day can bring. A typical day might include assisting elderly members of the community that may have had a fall or require support for their complex medical histories, anything from diabetes to heart disease and respiratory illnesses. We may be required to support people with mental health and drug and or alcohol-related issues. We also attend road trauma on a regular basis, and a variety of medical and trauma-related complaints. An important skill for paramedics is being adaptable, not only in managing patients with multi-faceted and complex presentations, but also the ability to manage a cardiac case, and then within minutes be required to deliver a baby, only to then be required to assist in road trauma.
Are there any times of year when you are busier than others?
I am based in Melbourne’s outer south east. In my area the workload is generally consistent throughout the year, with the exception of days such as New Year’s Eve. Periods of extreme heat also increase workload significantly across the state as can bushfires. Paramedics who work in coastal and holiday destinations see a significant increase in their workload during summer and school holiday periods and a reduction throughout the cooler months.
What are some of the challenges that face you on a day-to-day basis? How do you overcome these?
You are continually learning as a paramedic. A busy workload means we are often out and about serving the community so it can be a challenge to keep up to date with clinical changes and updates. I like to allocate set time each week for clinical review and education.
Paramedic safety, particularly relating to manual handling and occupational violence, is a significant challenge that presents a risk to each staff member. We have continued training and zero tolerance to occupational violence. It is important paramedics remain alert and vigilant as well as continually undertake dynamic risk assessments to minimise the risk of being injured.
When do you find your job most rewarding?
For me, it’s when you are able to make a positive difference to someone and their families, and they give you their heartfelt thanks. To me, it doesn’t matter if it is a large case with significant clinical interventions or a lower acuity case in which someone requires your support and assistance. The ability to make a difference and improve what is often very difficult for the patient is the most rewarding component of the job.
How important is it to take care of your own physical and mental wellbeing in this role and how to you do this?
It is critically important to ensure you are fit and well, not only to do your job well but also for your own health, wellbeing and happiness. A paramedic’s typical day can be busy and the constant change from day to night shifts can be detrimental to your sleeping patterns. For me, it is important to maintain regular exercise and eat a balanced diet. I try to ensure I have some work-life balance and not take work home with me to my family. I engage with AV’s SMART (Stress Management And Resilience Tools) program, which is a program designed to proactively review and monitor your mental wellbeing and allows for early recognition of signs of PTSD (Post Traumatic Stress Disorder), anxiety or depression. Early recognition and implementing strategies to reduce risk can have significant benefits in improving your overall health.
What are the main procedural changes that you have seen in recent times?
Ambulance Victoria is always looking at how we can continually improve clinical care and processes to advance our level of care and improve patient outcomes. I commenced as a paramedic in 2001 and I have seen a number of changes across the organisation over this time. We have seen the introduction of CPAP (Continuous Positive Airway Pressure) for both ALS and MICA paramedics and the provision of 12 lead ECGs for MICA paramedics, which assist with the early diagnosis of a STEMI (ST Elevation myocardial infarction). More recently we have also seen the introduction of pre-hospital thrombolysis for patients experiencing a STEMI in regional Victoria.
There have been significant changes to the way we treat road trauma patients. In November 2013 the Trauma Time Critical guidelines were updated to reflect the extended timeframe to triage patients to the highest level trauma service from 30 minutes to 45 minutes, and, as a result, more patients are being triaged to the highest level of trauma service. The introduction of RSI (Rapid Sequence Intubation) for MICA paramedics, which has now been part of MICA practice for more than a decade, is also significant. Research has found in adults with severe traumatic brain injury, pre-hospital RSI by MICA paramedics increases the rate of improved patient outcomes at six months compared with RSI in the hospital setting. MICA flight paramedics can also administer blood to patients. More than 145 patients have received blood since the procedure started in April 2011, with the bulk of patients being road trauma patients.
Ambulance Victoria is also involved in several significant research projects. These include the Monash University-led POLAR trial, which is investigating if the early cooling of patients with severe traumatic brain injuries leads to better patient outcomes. We are also involved in the PATCH study, a multi-centre randomised placebo-controlled and blinded trial to assess the effectiveness of pre-hospital administration of tranexamic acid for severely injured patients at high risk of acute traumatic coagulopathy. The study aims to determine the overall benefits and harms of pre-hospital treatment with tranexamic acid, and whether it improves survival and recovery at six months.
In addition to the significant advances in clinical care, we have also seen changes in our manual handling practices, including the provision of several Complex Patients Ambulance Vehicles to assist with the transport of complex patients and the inclusion of several pieces of manual handling equipment to make it easier to move the patient while minimising the likelihood of injury to the paramedic.
Are you anticipating any positive changes in procedure or legislation that may be in the pipeline?
It is an exciting time for Ambulance Victoria following the release of the Ambulance Policy and Performance Consultative Committee’s final report in December 2015. The report flags several reforms, including increasing the use of our secondary triage service and improving community awareness about when to call Triple 0 for an ambulance.
The secondary triage service links people to alternative appropriate health professionals in order to ensure emergency ambulances are available for the sickest patients in our community.
Increasing the quantity and quality of training for operational staff is also a major priority over the next 12 months.
As outlined in the Ambulance Performance and Policy Consultative Committee final report, we are implementing 40 hours a year of continuing professional education for all operational staff.
The increased training is more than double the number of face-to-face training hours per operational staff member in 2014/15.
What are some of the challenges facing paramedics in the field? Where are the gaps that if filled, would make a real impact to how you deliver your service?
Non-urgent calls can impact our ability to respond to life-threatening cases. Whilst we always want people who are truly sick to call for an ambulance, it is important for the community to understand the impact non-urgent calls can have on resources. We need to make sure we keep our emergency ambulances available for the sickest patients in the community.
It can also be frustrating to attend call outs which may be avoidable, especially when there is a lot of public education and repeated warnings about them. For example, paramedics were called to 1433 cases of children locked in cars in the year to 31 August 2015. While many of these cases were accidental, some of them were deliberate. Leaving a child in a car is avoidable and can have potentially lethal consequences.
Alcohol is a significant issue in society and has obvious impacts on the work of paramedics. Paramedics were called to 12,482 alcohol-related cases in metropolitan Melbourne in 2013-14 and 4043 in regional Victoria. Many of these cases were avoidable.
Can you give me any examples of how technology is helping your paramedics to improve patient outcomes and reduce job stress?
We have recently replaced our helicopter fleet. The new AW-139s are faster and can travel longer distances than our previous helicopters, meaning our MICA flight paramedics can provide even better patient care. MICA flight paramedics have also been trained to use an ultrasound machine, meaning they can better identify bleeding in the abdomen and can give the destination hospital early information about the patient’s injuries and condition.
With the introduction of 12 lead ECG machines, we have also used technology to allow for the ECG to be transmitted before the ambulance arrives at hospital. This allows the receiving hospital staff to analyse the ECG and prepare for interventions prior to the patient arriving, therefore minimising the delay to the patient and improving their chance of a full recovery.
The provision of Mobile Data Terminals (MDT) with satellite navigation in metropolitan ambulances has improved communication with our communications centre and hospitals, while also providing additional guidance to locate a patient. This can be particularly valuable for students learning to navigate streets they may not be familiar with.