By: Robert Mckenzie
Media Liaison Officer: Emergency Medical Services
KwaZulu – Natal Department of Health
My morning would start like any other persons morning, I presume. Except there are messages on my phone, about motor vehicle collisions and incidents that happened the night before and properly loving coffee more than most? While driving to work, Iam already starting to prepare myself mentally for the day ahead, which is quite hard, as you don’t know what’s going to happen during the day. The day shift is from 07h00 to 19hoo and I’m standing in on a shift that doesn’t have an Advanced Life Support paramedic.
Emergency Vehicles at the base at shift change, when I came on duty
When I arrive at base, I’m met by some of the off going paramedics who had worked the night shift. They are over tired and in a light hearted mood, glad that their shift is over. I asked how the night was and “it was crazy man” was the sort and brunt answer I got, I should have known it was busy, it is an end month weekend and some of the crews had travelled several hundred kilometers during the night.
I met the night shift paramedic in the Advanced Life Support paramedics office, which is more of a mini store room with medical stock and different kinds of medical equipment and monitors kept there, than a traditional office. She had just returned from an ICU transfer, where a patient is moved between two hospitals. A brief, “you just have to change the oxygen and I’ll see you tonight” was the very brief but conclusive hand over as she walked out of the base directly to her car, deliberately not stopping to talk to anyone, as it would delay her getting home and into bed.
A quick staff parade is done before checking the response vehicle. You have to check not only the vehicle for defects and damages etc., but also all the medical stock and equipment, you need to check that the equipment works and is charged and that there is enough medical sundries. As a rough guide we try to keep enough stock on the response vehicle, between our jump bags and the spare stock on the spare bags to be able to start basic treatment for a mini bus load of patients (which is normally 16).
Staff cleaning the ambulance before going on a case
After checking the response vehicle I make a turn at the Emergency Call Management Centre, where the emergency calls are received. Some of the day shift paramedics have already taken details for cases; there are still cases where an ambulance needs to be sent. I help the dispatcher reprioritize the cases, which are mostly assault cases. While in the center, a call comes in, there has been a house fire and the police and fire department who are on scene, suspect that an elderly lady has died. An ambulance crew and I are dispatched to the case. On the way to the case I’m reminded of the diversity of the people we encounter. What reminded me of this is on the main road on the way to the case, some people were just milling abound, others standing around a car parked on the side of the road, listening to music, while others dressed in their church clothes, were waiting for their lift next to the road. Due to it still being early and cool, there were also a few runners exercising, which included runners ranging from fit looking athletes to a small group of teens in their karate clothes. Just after turning off the main road and starting to look for the scene I was stood down on the case, the ambulance had already reached scene and sadly the lady had already passed away. An unattended candle left burning during the night being the suspected cause of the fire.
I was dispatched straight way, to another case. This time a medical case, about half an hour away. On the way I was listening to the two way radio as the other ambulances were arriving on scenes that they had been dispatched to, but there being no patient and the cases were being made exempt.
When I got closer to the area I had to get directions to the scene from the ambulance crews who are more familiar with the area. Navigating in the rural areas is not the same as the urban areas, very few roads have names and if they are named they are not marked, there is no street numbers, while some of the houses have a five digit number painted on the side, there doesn’t seem to be any logical numerical relationship between the numbers. Directions are normally in the form of land marks, like community halls, bridges, schools and little spaza shops.
A picture of the surroundings where is stopped to get directions to scene
I know which turn off from the main road I need to take and then I am told I need to pass two schools on my left and the scene will be before the blue tuck shop. Not long after turning off the main road the road turns to gravel and I’m reminded why our response vehicles are 4×4 bakkies and not the sports cars that some paramedics in the cities have. After driving for some time I suspect I may have gone too far and I ask for directions from a mini bus driver, who doesn’t know the name of the shop im looking for but assures me that I have proceeded to far. The mini bus driver was inadvertently right; the emergency call management center had been in contact with the family of the patient, who said they saw me drive past. So I turned around and proceeded back in the direction I had come from. This time I managed to see the sign board “lucky shop”, which was in fact a red shipping container and not a building as I had been expecting.
The ambulance arrived on scene shortly afterwards and we treated the elderly patient for the medical condition which she was presenting with for the first time. One thing many paramedics forget is that during emergencies you have to treat the patient and the family. The patient, for which ever condition or injury they have and the family who are normally very concerned about their relative and need to be reassured and informed as to what has been done for the patient. We then transported the patient to hospital in a serious but stable condition. At the hospital the doctors and nurses were still busy treating the over influx of trauma patients from the previous night.
A panoramic picture of the scene where we picked up the patient, with “lucky store” on the right
We handed the patient over to the doctor. The ambulance was given further details and I started to proceed back in the direction of the base. On the way back to the base I came across the fire department and a tow truck parked on the side of the road, I thought there may have been a collision that they were attending, but it was for a car that had caught alight. The fire department had already extinguished the fire and the driver had managed to escape without any injuries, but the car was severely burnt and beyond repairs.
The car that burnt out
When I got back to base there was no time to put my feet up and relax, I had plenty of admin work to complete. A laborious, but vitally important task, especially in the medical field. As fate would have it I was saved from too much admin work, I was dispatched to a bottle store, were two men had been fighting and they assaulted each other. To my relief, when approaching the scene I could see that the police were already on scene. Two men had an argument- (apparently about the one owing the other six Rands) and the one was hit on the head with a bottle, the other man had been taken away from the scene by his friends. I bandaged the man’s wounds and checked his vital signs. He was stable, but due to being under the influence, he didn’t realize the severity of his wounds and tried his best to convince the police man for a lift to his house. He eventually realized that he needed to go to hospital for stitches and when the ambulance arrived he was transported to hospital, where he was later discharged after being sutured.
Midafternoon, there were no cases outstanding and some of the ambulances were dispatched to transfer stable patients back to the hospitals they had been transferred from, while other ambulances were available from the base. Early evening I was dispatched for a motor vehicle collision about 40 minutes away from the base, the shift supervisor and I responded to the collision. There are road works on the section of road that we had to use and we battled to respond passed the vehicles, but we eventually managed to get pass the road works section and all the vehicles and made it on to the open road. While driving I noticed a truck on the side of the road, with its hazard lights on and a few people standing behind the truck, with others still running closer, they were standing around a man lying motionless on the side of the road. I realized that he had been hit by the truck. The accident had just happened! The station officer continued on the original accident, I stop to assist the man. I parked my response vehicle between the oncoming traffic and the injured man, it was on a bend in the road and its almost dark, I was worried that ongoing vehicles are going to hit us while standing on the side of the road. Using the two way radio I asked the control center to send the police and an ambulance to come and assist me.
I carry my equipment to the man’s side, some of the by standers are already crying, they thought that the man is dead. I asses the man, he is critically injured but still alive. I’m still the only person from the emergency services on scene but I start treating the man, giving him oxygen, putting up drips and connecting the relevant monitors, to check and monitor his vital signs. A police van arrives from the nearby station and the one policeman puts on gloves and helps me while the other policeman assists with traffic flow passed the scene. When the ambulance arrived, the ambulance crews assisted me to treat the patient. We administered the required medical care to the man and loaded him into the ambulance, by this time it was dark and had started to rain and we were glad to be off the side of the road as cars were driving fast around the corner and passed to scene, despite early warning by the Police and RTI.
The trip to hospital seemed to take forever as we had to pass though the same section of road works to get to hospital. The hospital had been updated regarding the patient and there was a trauma team waiting for us when we got to hospital, who I handed the patient over to. During the hand over to the Doctors, you tell them what is wrong with the patient, what the injuries are and what your treatment has been, you then also complete a written hand over, which the Doctor signs, which goes into the patients file.
It was already well after 19h00 and when we got back to base some of the night shift crews who were now rested, were full of energy and jokes ready to start their last night shift before going off on their rest days.
While driving home, I was thinking about the case I had just done, is there anything I could have done differently or better and if he will be OK, thoughts which ended quickly when I got home , as my tired son screamed “daddy’s home”. My baby was safely asleep and my other son needed to be carried to bed after falling asleep on the couch, not managing to stay awake to see dad.
My working day was over for now; I was at home- or now at least-, something which I cherish, because a paramedic is never really off duty. There is always a phone that can ring, with the person saying “there is a child”, “there’s a bus overturned”, “multiple critical patients, we need you”, “there is a…..” before you can even say hello.