What’s in your pocket

With everyone on Twitter emptying out there flight suit pockets to show what they carry on shift I wanted to draw particular attention to a peice of kit I carry every shift.



This box is my survival kit.  The tin is a black “tobacco” style tin, with an Australian Flag sticker and two pieces of glow in the dark tape.
Built from scratch based on useage and others recommendations and experience.
What does this have to do with paramedics?
Not much, however it’s an item you should give consideration to if your work puts you in remote locations frequently.
Where phones don’t work and radio coverage can be spotty, a breakdown or the Ambulance being disabled by a collision with wildlife could find you in a situation where the only option is to survive of your car supplies until help arrives.
This box is supplemented by 4L of water carried in my shift bag that’s gets moved from Ambulance to Ambulance for every shift.



This is it, first packed up and layed out.
From left to right you have
1. Two “riggers” rubber bands
2. 25 ft of Kevlar Cord
3. 1 pack of Steri Strips
4. “Commando” wire saw
5. Safety Whistle
6. 10 water purification tablets
7. Gerber Dime Multi Tool
8.Wet fire tinder tab (white bag)
9. Quick fire tab (zip lock bag)
10. Button compass
11. 2x Oven bags wrapped with “riggers” rubber bands (water carrying, transpiration collection)
12. Striker rod
13. FRED can tool/ spoon
14.aviation survival striker tool (like a lighter wheel)
15. 2 meters of Duct Tape
16. 2 packets of sutures (emergency sewing)

While it rarely gets used for its intended purpose, surviving without much else, in the event of catastrophic event. Leaving me without transport, this kit is designed to provide me with tools that are difficult to make or find in the initial hours.
Often I use this kit for general problem solving, duct tape and sutures being the most used items for minor repairs.

If you work in regional areas thought should be given to extra water, change of clothes and some food. If your concidering making your own kit its an easy process with a number of how to guides online. It doesn’t have to be in a hard tin or contain as much as mine it has to be a kit you carry and know what’s in it and what you use it for.

Get on twitter and show off what’s in your pockets when you clock onto shift!


This is what I carry day to day, plus the above tin.

This is Australia! Where the bloody hell are you?


Green rolling hills on the way back from Orange


A well loved resident in a local Nursing home (bottom left)


Roadside stop on the way back from a long transfer


Stained glass window in a Hotel


Sunset Over the Ardlethan Medical Center


The disused Ardlethan Tin Mine


Take off from a small coastal airport


Canola fields


Extremes of Weather


Rainbow out the front.


Dirt road response

This Australia day take a look at the best office in Australia.
Rural and Remote Paramedics is the best job you’ll ever have and in country like this you’ll have a hard time leaving!

Talking HEMS, Ski Patrol and international Paramedicine with JD Graziano


DSCOT Blog would like to welcome its first international guest, @AJDGRAZIANO

JD has had basically every job in US paramedics and I was thrilled to finally chat to him (we’ve been planning for about 4 months now to talk, since before Podcast 1).
We had a few setbacks, moving house, power outages and being the polar opposite shift. But we got there, and it was great to have my first international presence on the show.
We covered many of the differences between out two educations and work environments, from how and where we trained right up to our present day work environments. There’s a lot to learn in  this podcast and based on the 30 minutes we talked before the start of recording I think we should have a fairly exciting talk coming up when we record.
JD is from the US and has recently begun working in flight Paramedicine. After his beginnings in Ski Patrol, ground EMS and Mountain guiding.

JD has also had a few appearances on the PHARM podcast (by Dr. Minh Le Cong) and been on the live show May 2013. You can check that out here


Once again the I tunes link: https://itunes.apple.com/au/podcast/downstairs-care-outthere-podcast/id876296199
If you have 2 minutes please leave some feedback, rate the podcast make us easier to find for Australian Paramedics! If you want to leave some feedback (positive or negative I want it all) , I read it all please contact me via twitter or the contact form below. That will deliver an email right to me and if I’m having a slow day you’ll hear back in and hour.

If you would like to listen without I-Tunes there’s a link right here direct to the host site. You’ll be able to access everything from the Podcast that I’ve published to date.



Some information you may find useful through out the talk;

A Howitzer being fired into the side of a mountain to trigger an avalanche.


Ski Patrol Toboggan

Wilderness Medicine
The basic run down of the Curriculum in the States: http://www.nols.edu/wmi/admissions/recertification.shtml

If your interested it taking a Wilderness course in Australia:



(no commercial interest, just two courses I hope to make it to one day)

Pararescue (PJ’s) for those unfamiliar are US Airforce Special forces: http://en.wikipedia.org/wiki/United_States_Air_Force_Pararescue

Boyds Loop (how to make decisions)  :



EZDrugID campaign – be a lifesaver!


A great idea, do the survey, retweet and share and put 30 seconds towards a cause that affects all in healthcare

Originally posted on PHARM:

Attribution to Dr Nicholas Chrimes Attribution to Dr Nicholas Chrimes

Join the WORLDWIDE CAMPAIGN to save lives!

View original

How do you quite a room of People

Catching up on my #FOAMed after the Christmas Break I came across the TAC 20 year Commercial I’ve seen this 3 times in my life, today, when I was training to be a paramedic and once at university.
I remember the reaction like it was yesterday.  We’ve all been in a room of paramedic students before, each video begins the same way.
Chatter, a few people finishing off their conversations, the odd joker throwing something out to a some chuckles.
This all stopped at about 2 minutes. When people started to realise what we were beginning. A course that would put us directly in the line of fire for dealing with these types of emergencies.
So as an exercise in reflection watch this video, quietly by your self and think about what we do.

Then look at these photos and think about what we do.

This is what we risk, driving fast carries significant risk to us.

There are to many factors to account for, many that you don’t have control over.

Don’t be afraid to ask your partner to take over the driving duties on a longer shift ( We used to work Treating/ Driving days in metro, now we work job about where we switch roles after each job)

Don’t be tempted to over exert your self before night shift. Ensure you rest prior to the shift.

088472-ambulance-crash 130532-ambulance-crash84080-two-injured-in-orkney-ambulance-crash130587-ambulance-crash362141-ambulance-on-its-roof-at-north-adelaideAccident30r527117_2968392

Take care out there, not just around the holidays but all throughout the year.

Crowd Sourcing CPR

Practice CPR as a first year!
6 years ago and much younger looking

Welcome to the new year!

First up the I-Tunes link! This will work with RSS feeds and I-tunes for all the podcast goodness

Kicking off the newyear with a Podcast between my self and David Still from the ACT @Davidstill
David is a 4th year Paramedics/ Nursing Student (he was in 3rd when we recorded) who recently submitted a conference poster on the use of smartphone activation of public response for apparent public cardiac arrest.

He also participated in the FERNOSIM as a member of one of ACU’s Teams and we have a little reflection on how they could have trained better.

The link to my I-Tunes feed for the podcast are right here, please, if you enjoy it subscribe leave a review and come and interact on the blog or twitter.
If you haven’t already share the podcast with your friends, get it going around. Try and use the new year to get someone into #FOAMED
For all of Australasian Journal Of Paramedics:


Abstracts for SPA 2014


Abstracts for PAIC 2014


The papers David and I talked about relating to his poster, complete with links to find them, a few are behind paywalls.

American Heart Association. Improving Survival From Sudden Cardiac Arrest:
The “Chain of Survival” Concept. Circulation. 1991 May; 83(5): p. 1832-1847.


Brooks S. Abstract 191: Community Uptake of a Smartphone Application to
Recruit Bystander Basic Life Support for Victims of Out-of-Hospital Cardiac
Arrest. Circulation. 2012;(126): p. A191.

Brooks S, Worthington H, Gonedalles T, Bobrow B, Morrison L. Implementation
of the PulsePoint smartphone application for crowd-sourcing bystander
resuscitation. Critical Care. 2014; 18(Suppl 1): p. S176.


Scholten A, van Manen J, van der Worp W, Ijzerman M, Doggen C. Early
cardiopulmonary resuscitation and use of Automated External Defibrillators by
laypersons in out-of-hospital cardiac arrest using an SMS alert service.
Resuscitation. 2011;(82): p. 1273-1278.


Yonekawa C, Suzukawa M, Yamashita K, Kubota K, Yasuda Y, Kobayashi A, et
al. Development of a first-responder dispatch system using a smartphone.
Journal of Telemedicine and Telecare. 2014; 20(2): p. 75-81.


Ringh M, Fredman D, Nordberg P, Stark T, Hollenberg. Mobile phone technology
identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac
arrest victims prior to ambulance arrival. Resuscitation. 2011; 82(12).


Grasu A. SMS alerts for volunteer rescuers in the emergency system: Decreasing
the delay in starting cardiopulmonary resuscitation [abstract]. Resuscitation.
2013; 81 (Suppl 1).


Zijlstra J, Stieglis R, Riedijk F, Smeekes M, van der Worp W, Koster R. Local lay
rescuers with AEDs, alerted by text messages, contribute to early defibrillation
in a Dutch out-of-hospital cardiac arrest dispatch system. Resuscitation. 2014.


American Heart Association. Primary Outcomes for Resuscitation Science Studies:
A Consensus Statement From the American Heart Association. Circulation.
2011 (124): p. 2158-2177.


Merchant, R., Asch, D., Hershey, J., Griffis, H., Hill, S., et al. A Crowdsourcing
Innovation Challenge to Locate and Map Automated External Defibrillators.
Circulation: Cardiovascular Quality and Outcomes. 2013 March, 6(2): p. 229-
236. DOI: 10.1161/CIRCOUTCOMES.113.000140


11. Sakai T, Iwami T, Kitamura T, Nishiyama C, Kawamura T, Kajino K, et al.
Effectiveness of the new ‘Mobile AED Map’ to find and retrieve an AED: A
randomised controlled trial. Resuscitation. 2011; 82(1): p. 69-73


If you would like to read further into what is being done with mobile phones;



Featured photo is me and a classmate practicing CPR as first years at CSU 2009.
Facilities were basic, but the staff were motivated and challenging.

Pelvic Fractures

Originally posted on Little Medic:



  • Pelvic Fractures occur in 5-11% of all major blunt Trauma 
  • Early Suspicion, Identification, Management and Triage are critical for good outcomes
  • Mortality is between 7-19%. (mortality increases to ~50% in open pelvic fracture)
  • The Most Common Mechanism of Injury resulting in pelvic fracture is MVA (Motor Vehicle Accident)



  • Springing the pelvis is BAD! don’t do it! (springing to asses for fracture has a specificity of 71% and a sensitivity of 59%, suggesting that routine use of this examination should be abandoned.)
  • Instead, pain, MOI and S/Sx should be sufficient indication for management and radiology.
  • In this study, 90% of pelvic fractures involved the Pubis along the Rami.
  • In the Gonzalez et al‘s study ( Gonzalez R P, Fried P Q, Bukhalo M. The utility of clinical examination in screening for pelvic fractures in blunt trauma. J Am Coll Surg 2002. 195740.) of patients with GCS 14 or 15, the most common positive finding in patients with pelvic fractures was…

View original 191 more words

Pelvic Binding and Prehosptial Traction Splinting, Results of a Survey


Ove the past few months I’ve been running a Poll via word press and eventually a more comprehensive survey on the use of Prehospital Pevic Binders and Traction splints

The G+ Conversation that started it all

Over all I’ve had 75 responses to the survey. While this is by no means exhaustive it provides a basic idea of what the world are doing.
Respondants were sources via twitter and came from Australia (various states), UK, USA, Canada, South Africa, Scotland, The Middle east, Ireland and Sweden (listed in prevalance of response).

Brands of binders: SAM II, T-POD, Bedsheets + Clamps, Promethus Binder, KED.
Brands of Traction Splint, Donway, Hare, CT-6, Sager, Trac 3.

88% indicated that pelvic binding was indicated by their service and they have equipment to perform it.

97.33% of respondants are using a Traction Splint on Femur Fractures w/o pelvic trauma.

 48.54 %of respondants indicated that their service had in place a protocol for dealing with multi trauma of pelvis/femur.
22.06% indicated no guidance for Pelvic and Femur traction concurrently.
13.24% have a protocol but it isn’t routinely applied by clinicians and 16.18% indicated that they don’t have a protocol but providers have applied it.

Respondants included, Paramedics (Road and Air based), flight RN’s, Students, Numerous Doctors from all around the globe. 
Doctors were the most international group and paramedics came a close second.

While this was in no way intended to be exhastive research into what is applied as standard it was intended to give a general view of the Prehospital managment of specific traumatic injuries.
In the absence of evidence we practice based on concenus opinion. The responses were gathered by me for the purpose of better understanding what the Prehospital Community is doing world wide with there pelvic and femur fractures.

Thanks to all respondants, I hope this serves as a gathering of a small ammount of information to enlighten you as to the current state of play.

If anyone ever wants to talk about this, bring along the evidence your service or hospital is using and we’ll get a podcast going



Institute of Trauma and Injury Managment


Adult Trauma Clinical Practice Guidelines; Managment of Hemodynamically Unstable Patients with a Pelvic Fracture:   


If your still hungry to learn more:

Initial management of pelvic and femoral fractures in the multiply injured patient

Amer Mirza, MD, Thomas Ellis


Featured image from:


Some of the information provides during the talk.





A Link to the podcast it will be in your I-Tunes shortly. If you haven’t subscribed, please do! Leave a comment, recommend me to your friends.



“Are you crazy?” “Have you been there.”


This is what people asked, when I told them I was going regional, leaving a large Metro sation with 10 cars running around daily for a one car staion in regional NSW.

I can say confidently after two months that I have made the right decision.

To those looking foward to posting cycles with angst, don’t! Some people dispair at posting to a rural or remote area, it can be one of the best experences of your life.

I dare say if your here you like to practice as a clincian rather than a technician, going rural allows you to do that, with greater distances to travel and sicker patients you get to really learn your craft as a paramedic, I’ve used procedures out here that I rarely touched in metro.

Being the first point of contact with the health system for many people in the community makes you a valued individual.

You get to see some stunning scenery, not only from your home  (where I regularly view a beautiful sunrise) but in the country arround you.

I was told every horrible thing about the place that I am before I even arrived, but the bad sticks much longer than the good in peoples minds.

The good doesn’t get dragged up as much but it is out there.

So don’t dispair, Rural isn’t the end of the world, but the start of a glorious career in the best job in the world!

Happy New Year to all out there, if your on shift, stay safe, if your celebrating likewise, stay tuned in the New year for more podcasts and some learning resouces for paramedic students or Paramedics wanting to reafirm their knowlage.

I’m back, finally


Sorry for the silence over the last little while, be assured the podcast and blog will be back in full swing shortly, I’ve now relocated from Metro to Rural,unfortunately the process behind that left me rather busy between relocating and working my job, I’ve not had much time to put words to paper.

The blog will remain the same, the podcast should increase! Lets see what the future brings.
All I ask is that you remain loyal throughout this transition period!

Mitchell Thomas


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