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A Paramedic Intern in the Northern Territory – A Personal Experience

9 Dec 2016

‘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!’