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A selection of stories from our CRANApulse magazine written by remote health professionals or students during their clinical placement
A Paramedic Intern in the Northern Territory – A Personal Experience
‘Do you want a job as a paramedic in Darwin?’... ‘Yes please! Where do I sign?’ A few weeks after travelling to Darwin for an intensive 2-day interview process, Trent Ramsay received the above call from the St John Ambulance Australia Northern Territory (SJAANT) recruitment officer.
Working as a paramedic in the Northern Territory had been my dream and goal for a number of years…dreams do come true!
The first question friends and family asked me was: ‘Why the Northern Territory?’ The land, according to local lore, where every creature not only wants to kill you but has more than enough ability to follow through…
The NT has a lot to offer. It’s a place of great beauty, amazing waterfalls, stunning coastlines, terrific camping, friendly people, delicious food. And for paramedics – a great diversity of patient presentations.
During the first day of paramedic induction all the fresh new graduate interns walked into the classroom nervous and excited. We called ourselves ‘The Foxtrots’, after we found out ‘Foxtrot’ was the clinical call sign on the radio for interns.
The Foxtrots instantly united as our new family away from home. The next five weeks of induction were full of laughs. This was followed by the non-clinical week at the end — the part that everyone was looking forward to… the driver training. This included: spinning out of control in a skid car, speeding as fast as possible in an ambulance around a race track, and heading into the bush for some epic 4WD training.
Then the sad part came…the day the new family of Foxtrots was separated. Half of the Foxtrot family would work in Alice Springs and the other half would stay in Darwin. This was the beginning of our own on-road journey.
This was also the beginning of the ‘firsts’; when we all were very jealous in a ‘sick’ paramedic way of the first person to perform intravenous (IV) cannulation, insert an laryngeal mask airway (LMA) down someone’s throat, use the Intraosseous (IO) (bone) cannulation drill, first big motor vehicle accident (MVA), first resuscitation.
I had one of the firsts – I was the first to have my bum pinched by a patient. When I mentioned this during my patient handover at the hospital bedside it caused a sudden giggle from the half a dozen female staff present. I was also the first, but not the last, to drop a stretcher on scene (not with a patient on it). This is a common newbie mistake as a result of not locking a latch on the stretcher properly when lowering it to half way. As I turned red, the very experienced Intensive Care Paramedic (ICP) I was working with calmly and reassuringly said with a slight grin, “Oh no, my mistake Trent. I meant to say let’s half-height the stretcher”. From that point I realised the paramedics in the NT had a great personality and cheeky sense of humour.
My next two months were split between two excellent paramedics, a Scot and Jeff, the experienced South African ICP from my first job. During these first two months I was frustrated at not being as competent as these two experienced paramedics. Both laughed at my frustrations and mistakes and then we all laughed knowing that every paramedic starts their journey at the beginning.
The next four months were with Phil, an experienced paramedic from England. We would reassure our patients that between the two of us ‘we have twenty-seven and a half years’ experience. Phil has twenty seven and I have half a year! I learned from Phil how to become confident and competent in the job and how to keep my approach simple and appropriate.
The following six months were with Dave, another experienced paramedic from Scotland. Dave taught me how to make patients laugh and feel comfortable while assessing and treating them. Dave emphasised the importance of working within a team. He also led by example in demonstrating the importance of keeping everyone happy – from the cleaner, to the nursing home staff, to the bosses, to the hospital staff, to the police….and most importantly the coffee shops. When reflecting with Dave on my practice and what I needed to improve on he said, “Trent, we do a very quirky and diverse job. The sooner a paramedic understands that and enjoys the different elements of the job and the unique side of people we encounter, the more enjoyable the job will become. Paramedicine can be a funny job at times – so don’t forget to laugh and smile every moment you can”.
Then there are the station officers, managers, and education team. These people support and keep the interns in line. I may have been guilty of needing to be kept in line on the odd occasion. The relationship with the bosses made it hard to get through a shift without having a laugh. They were always there to support me, discussing research, answering my thousands of questions and challenging their staff in a number of ways.
At one accident when a pedestrian had been hit by a car travelling at night on a 100 km/hr road I had been tasked by the lead treating paramedic to insert the IO (bone needle). I had practised this skill hundreds of times in the simulation room. Now I had to step up and apply this skill in real life. The station officer gently guided my trembling hand as I felt the pressure of the importance that this IO needle be inserted correctly to give this patient the best chance of survival. I wearily peered past my colleagues to the unresponsive person lying in front of me. The scent of alcohol was prevalent. I closed my eyes for a second, took a big breath and reassured myself that if she was unfortunate enough to feel the very painful and almost medieval procedure it might mean she is not as sick as we were suspecting and the outcome for her might be survival… I pierced the needle through the skin; made contact with the hardness of the bone, I cautiously drilled the needle until I felt a pop of the bone and the needle was in the right place. It was an eerie feeling… I just drilled into a person’s bone… I drew back the bone marrow into a syringe… Relief! It was successful and now we were able to administer medications and fluids to hopefully bide her time before the emergency operations she would need at hospital.
For the majority of the aboriginal patients, it is important to speak simple English and commonly known phrases unique to the Northern Territory. I take my hat off to this ‘mob’ (group of people), many speaking English as their third, maybe fifth language, and many coming from hardship and trauma. But boy do these people know how to have a laugh, and the kids can certainly be cheeky and full of fun.
Common phrases you learn in the NT include the pain scale — ‘small, medium, or big mob’s pain’, homeless/no fixed address – ‘long-grasser’, short of breath – ‘short wind’, assaulted by two or three people, ‘double banged’ or ‘triple banged’, allergic reactions – ‘do any medications make you sick?’ Common patients’ illnesses in the Northern Territory include: missed dialysis complications; cardiac problems including rheumatic heart disease; assaults; infected wounds exacerbated by tropical weather and dirt; road trauma; and non-adherence with medication and treatment.
The Northern Territory has a road toll four times larger than the national average. The road toll was 49 for 2015. A number of factors appear to contribute to this: alcohol; speed; lack of seat belt use; excessive persons in cars; non pedestrian-friendly roads; and generally silly people.
The Northern Territory has ambulance stations in Darwin, Katherine, Nhulunbuy, Tennant Creek, and Alice Springs. I had the opportunity to work at all except Katherine. Nhulunbuy was a magical experience; a stunning costal mining town in North East Arnhem Land, a 15- hour drive from Darwin – “down the track.” This is a town of great community and culture. Whilst I was there, I had the opportunity to experience the power, authority, and strength of this mob’s culture at the four-day aboriginal festival, Garma. This festival includes great music, storytelling, dancing, art, basket weaving, spear making, and political chats.
After Nhulunbuy was my Tennant Creek experience. This town is 500 km north of Alice Springs and the locals here are proud ‘desert people’. I never knew what to expect at the beginning of a shift and one job in Tennant Creek was a great learning experience for me. We were dispatched to a motor vehicle accident 30kms out of town. This involved 1 car, 6 persons, and 1 dog. As I stepped through the remote clinic door as the designated treating paramedic, I remember thinking the place looked like a M*A*S*H‑style army clinic. As the youngest person in the room by at least ten years, no-one was more surprised than me that people were waiting for my next suggestion or asking my opinion on the next step that should be made including: the best way to assess and stop one of the patients bleeding, establishing a difficult IV cannulation, which medications to give, and which patients need to have aero-medical evacuation. This was a challenge that tested my leadership. It was a nice feeling when nurses expressed their sincere thanks for the help when we were leaving.
Other unique experiences for me included: running in uniform in the heat of Darwin for the emergency services race; donating blood for the emergency services challenge; helping with the first aid in the schools program; reading an ambulance picture book to primary school kids; my crewmate Dave and I becoming the new faces of the ambulance service on their television ad (the irony is neither of us had a TV to watch it); providing a “tool box chat” to construction workers on heat injury and dehydration; and having my belly washed in crocodile-infested water as a welcome to country during a remotely located CRANAplus Maternity Emergency Care course.
Of course there is the big test — the Authority to Practice final assessment. This consisted of a very nerve-wracking day including a written test, panel oral assessment and scenario. Following successful completion you get pats on the back from everyone and a welcome to the qualified paramedic team. If you’re thinking of coming to the Northern Territory for routine work, think a bit more…it’s an adventure!!! An adventure that’s hard not to love!’