Author:  Sascha Baldry

Editor:  Amelia Smyth

 

It’s 0645 as I make my way to the ambulance parked in my driveway. The air is crisp as the sun climbs, illuminating the vast expanse of blue sky over this south western region of New South Wales. I have not been called out to a job through the night so my shift begins at 0700. As I make the three minute drive to Coolamon station I see my partner arrive and we reverse the ambulances into the station plant room. I am a qualified paramedic employed by the New South Wales (NSW) Ambulance Service and I practice in the Murrumbidgee Zone of the Southern Sector in NSW. My set of five day-shifts begin at 0700 and conclude at 1800. I am then on-call overnight for five nights. Following this is five days off which I feel gives me a wonderful work-life balance, with plenty of time to enjoy my family and hobbies.

Coolamon is an historic town of 2100 people, 40km north-west of Wagga Wagga and about 500km south-west of Sydney. I have lived in the south-west slopes district for 25 years prior to gaining my paramedic degree and starting work “on road”. With my children now being the sixth generation of our family to be born in this area, this is home for us.

After arriving at the station my partner and I check the vehicles, their equipment and medications. All oxygen cylinders have a plentiful supply and anything with a battery is in working order. The airway, first aid and cannulation equipment is fully stocked and the portable kits that we take into each job are ready to go. I enter our information into the Mobile Data Terminal (MDT) in the ambulance. This is the electronic portal by which we receive all pertinent information from the control centre. The dispatcher calls the car via the two-way radio; “Coolamon 419 for sign on”. Our ambulance and its’ crew are ready to respond.

The control centre is responsible for assigning us to our incidents 24 hours a day, 7 days a week. The operational practice of ‘fluid deployment’ means that we may respond to jobs across the region, as required. The incidents that we attend can vary from life-threatening emergencies, to low acuity presentations, to inter-facility transfers. Today, I have time to check my email before the phone rings. Our first job is for a 68-year-old gentleman who has self-presented to the local emergency department following two days of central chest pain and a previous history of triple vessel disease. Tests have revealed a positive troponin and precordial T wave inversion. A provisional diagnosis of non ST-elevation myocardial infarction has been made and transfer has been arranged to definitive care.

I prepare the patient for the twenty-minute journey to Wagga Wagga: I change over his ECG leads to our Lifepak15, transfer his oxygen to our supply and cross check the doses of glyceryl trinitrate and morphine already administered by the local GP. Forward preparation prior to departing the hospital means that, in the event my patient’s condition deteriorates, I am able to deliver whatever is required rapidly. My patient is fully monitored and I have ready access to any drugs I may need to administer. Some of our transfers in rural areas can be lengthy and often take us through areas of soft, white cotton crops, enormous golden fields of ripe canola and paddocks of black cattle chewing contentedly. It’s a uniquely bucolic environment but you may find yourself a long way from help. My patient needs further pain relief en-route but we otherwise arrive safely.

The control centre returns us to Coolamon. Approaching the outskirts of town, the MDT flashes red with an incoming job as the dispatcher calls us on the radio. We have a 79-year-old female who has fallen at home. I read the incident details and learn this call has come from her personal alarm activation. We gain access to the little, fibro cottage via a key box and find our patient laying on the bathroom tiles. The house is stiflingly hot, the acrid odour of urine permeates the air and our patient is confused, tachycardic, febrile and cannot weight bear. We estimate that she has been on the floor for several hours. We also discover little food in her kitchen and a confusing array of partially opened medication blister packs. The antibiotics prescribed for her urinary tract infection just three days before lay unopened next to her bed. To assist in extricating our patient we activate our local NSW Fire and Rescue brigade, continue assessment and treatment and transport her to Coolamon Hospital. At handover we recommend an updated aged care assessment and medication review.

We have now been on the go for several hours. We arrive back at the station and take our “crib break”, the thirty minutes we have for lunch. In the quieter stations it is not often that we miss breaks, but it does happen occasionally. The rest of the afternoon is uneventful and I take advantage of the work space to complete an online education module on end of life care. In rural stations, our downtime is valuable for continuing study, completing post graduate degrees or undertaking research projects.

I complete my shift at 1800 and sign on to the car for on-call overnight. I drive the ambulance home and settle into my usual evening routine. I have been asleep for about ninety minutes when the phone rings. We have an urgent response for a 72-year-old gentleman in respiratory distress. I know this patient and mentally note this is the fourth time I have attended to him in the previous three weeks. He is a lovely man, in the terminal stages of chronic obstructive pulmonary disease, valiantly coping with his worsening exacerbations. It’s nearly midnight as I make my way to the ambulance parked in my driveway. The air is warm and a half moon illuminates the vast expanse of black sky over my head. I meet many wonderful people in this job and every day is different, which is part of what makes working as a paramedic such a privilege.

 

All personal information and scenarios have been changed to protect patients’ privacy