Fatigue in our workplace

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While my girlfriend was looking through some resources for work she found a Fatigue Risk Assessment and Hazard wall chart presumably developed for Mines NSW, So she sent it over to me to have a read of. She’s been working on her workplace policy for fatigue and avoidance of excessive overtime. Being the wonderful person she is and knowing I spend good deals of time on twitter and here talking about various things she occasionally provides some resources.

Here’s the where you can find it

http://www.dpi.nsw.gov.au/__data/assets/pdf_file/0006/309714/Fatigue-Risk-Management-Chart.pdf

This got me thinking about what we do, a lot of the risks identified are iatrogenic to our 24/7 365 best care out there model (IE. not readily modifiable) The points on the table where you as an individual have the most ability to affect change are the individual and non work factors

A few weeks ago I was involved in a chat on twitter about how best to do night shift.
The question from a Paramedic student, presumably in reference to up coming clinical shifts generated a number of tweets about different strategies

What I find work for me is, take as much time for my self in the preceding day as possible. As tempting as it is to go out, hang out with friends or have a bbq its going to hurt later (I have most friends well tuned into my 9 day roster).
I try to limit my caffeine intake in the AM and early PM to allow me to have a nap if the mood strikes. I try to avoid stocking up on sugar for nightshift, I find pushing back my dinner until 11 usually tides me over until the morning (this will of course be different) I try and avoid relying on the various brands of energy drink.
I find some light exercise, helps to wake me up for the shift a jog or some light cycling try to avoid muscle fatigue that won’t help.

After a shift I like to have breakfast, usually something light and wander off to bed, if its days off then I’ll have my girlfriend call around 1 or 2 so I don’t sleep through the day and wreck my sleep cycle.

Now for a Airline industry mnemonic! Because Twitter loves Aviation (and why shouldn’t we) Used by pilots to assess fitness to fly.

Illness
Medication
Stress
Alcohol
Fatigue
Eat/Emotion

http://en.wikipedia.org/wiki/IMSAFE

Now why did I start this with a story about how I found this via way of my wonderful girlfriend, because that’s what I think about when I think about fatigue, moving away from the patient safely issue we all like to talk about and bringing it back to a more personal point. The consequence of driving tired not only affects you, but loved ones, mates and other road users.
Don’t be afraid to have a nap after night shift, my lounge is often offered to paramedic students and everyone who’s a close friend knows how to get into the house where to find blankets and that they are always welcome to a kip on the lounge.
Fatigue its a huge killer on the roads. We have to operate through it by virtue of our employment. Watch this ad from Transport NSW and think about the message.

Stay safe out there

The featured photo was taken after I was coming back from a night shift that involved a long drive, after realising I was struggling I diverted to a friends house and took a nap under my jacket on the lounge, thankfully the 3 year old allowed Uncle Mitch some much needed sleep!

Are you OK?

Originally posted on PHARM:


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The cut segement from Jess’s talk on Peer Support and MH

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I cut a section from the interview with Jess, with her consent because I didn’t think it it fit the tone of our talk and it was important enough that it deserves its own podcast!

Jess and I both feel really strongly about personal mental health and taking care of others around you not professionally but as a friend.

Opening a dialog with your partner/ recognising when someone is in need of a vent/chat/debrief/breakdown what ever your calling it. This is a job, but its a job that has the potential for serious harm to occur if you don’t follow the warning signs.

Thank you to those who contacted me when we were talking about this on twitter.
That’s what we need to do more, start dialog talk about whats bothering us, find a trusted friend or partner, a senior manager, even request formal peer support if you have access to that.  

You work in a sometimes terrible job, for people to expect us to absorb all that and deal with it by ourselves is lunacy, that’s old way thinking and it doesn’t work.

Next, I want to start a new trend, when ever people meet us they want to know “Whats the worst thing you have ever seen”

Please I want everyone to get their family and friends to ask “whats the best thing you’ve seen/done” I’d rather share the happy calls than the unhappy ones. 

Thank you for listening
Mitchell Thomas

Link to the show, subscribe for instant updates to the show (ie; as soon as I upload them they will be in your feed)

https://itunes.apple.com/au/podcast/downstairs-care-outthere-podcast/id876296199

If anyone is in a donating mood these two groups do amazing work and don’t get any of the credit they deserve. 

http://www.beyondblue.org.au/?gclid=CjgKEAjwuMmdBRDljdfi2_qQpxkSJADDCRwsterw-IZwaOQT1YMSguYEmjFKIHmoh5l9CO264kV3ffD_BwE

https://www.lifeline.org.au/

 

 

 

 

When should resuscitation stop -Cliff Reid at SMACCGOLD

jrparameddscot:

Amazing experience being in the audience, Cliff is always asking practitioners to do the best they can for their patients.
If you haven’t seen his SMACC 2013 talk on how to be a hero its a must watch!

Originally posted on PHARM:

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Podcasts you MUST Listen to!

I know some people find the prospect of listening to podcasts daunting like a lecture, only your doing it on your Own time.

Well, I’m here to say there are some brilliant and exciting podcasts out there that will also round you out with a good knowledge.

Here’s my Top 5, I will also highlight which particular posts/podcasts to concentrate on;

1: EM Crit Acid Base; http://emcrit.org/podcasts/acid-base-i/
This is a 4 part series I wish I had at uni.

2: PHARM: http://prehospitalmed.com/2013/01/31/pharm-podcast-58-the-vortex-management-of-the-unexpected-difficult-airway/
The vortex podcast is probably my favorite, but in actuality everything’s good!
 3: AmboFOAM’s Heroin and Narcan Podcast

http://ambofoam.wordpress.com/2013/12/19/ambofoam-podcast-heroin-and-narcan/

4: EMbasic EMS: http://embasic.org/2012/02/20/the-prehospital-episode/

5: http://kidocs.org/2013/11/
Finally, while not a podcast an invaluable post on the subject of ETCO2, My initial education consisted of Purple=Bad, Yellow=good then ETCO2 embedded monitors like the lifepack 12/15 became common place in US and some Australian Services 

If your a student or a professional not listening to podcast’s your missing out on a huge chunk of education, if you want to know the cutting edge of care then podcasts/blogs are a good place to get that information. 

Doesn’t matter if you are a 1st year Paramedic student or a 20 year veteran of the profession, there is something in the FOAMed world for everyone to learn, you just have to find it. Which is half the fun. 

Jess (@EMS_junkie on twitter) On Student Paramedic experience and Nursing

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Jess and I at the Student Paramedic Dinner during SMACCGold

A few days ago I had the opportunity to catch up and record not one but two Podcasts with Jess!

It can be found here:

https://itunes.apple.com/au/podcast/downstairs-care-outthere-podcast/id876296199

The first one will be released and the show notes are below for that, however in 2 weeks or so there will be a special short podcast on a topic very close to Jess and I. 

For those who don’t know Jess, she’s a Nurse

within NSW Health, prolific tweeter, student paramedic and mum to two boys, she also somehow found some time to come out and record a podcast with me!

I first had the pleasure of meeting up with Jess at SMACCGold after talking briefly on Twitter. She’s always been an advocate for better mental health awareness (for both patients and providers)  

In this podcast, we discuss the transition between Nursing and Student Paramedic, going from Working in hospital wards to taking care to the streets, Jess shares some stories of both her time as a nurse and her placement with ACTAS.

If your on twitter you should be following Jess, if your listening to this podcast your going to hear how much she has to share.
 
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Shortly after this photo I descovered Jess hasn’t seen Starwars, so my Darth Vader I am your father (Spoiler Alert) was a poor joke, I hope our listeners get it!

Please subscribe to the DSCOT Podcast on Itunes, if you do give me a ranking and leave some feedback, Comments on the blog post or on twitter, if you ask questions for Jess, I’ll let her know to swing by and answer!

Some of the Links mentioned within the show, 

http://www.paic.com.au/  PAIC 2014 – A World of Opportunity@

http://www.studentparamedic.org.au/

Jess writing on Prehospital Research: http://prehospitalresearch.eu/?cat=333

News article relating to paramedic violence, one of many;

http://www.news.com.au/finance/work/ambos-twice-as-likely-to-be-injured-on-the-job-as-cops-medical-journal-of-australia-report-finds/story-fnkgbb6w-1226907588912

But paramedics arn’t the only ones affected
 http://www.theaustralian.com.au/news/nurse-stabbed-in-face-by-patient-at-redcliffe-hospital/story-e6frg6n6-1226936901303

Professor Brian Maguire; Occupational injury risk among Australian paramedics: an analysis of national data (open access)

https://www.mja.com.au/journal/2014/200/8/occupational-injury-risk-among-australian-paramedics-analysis-national-data

DSCOT Podcast 3 Aidan From Little Medic, Download link and Shownotes

So, after weeks of planing talking and threatening Aidan and I finally got together and recorded a short…. *cough* podcast.
Talking to Aiden was Amazing, I’m so glad he was able to give me his entire Monday, to record the podcast.
We talked about his time in Nepal, Israel, Ultrasound and SMACC GOLD and naturally Trauma!

 Sorry about the occasional back ground noise we recorded in  a cafe just outside central station.
I’m happy to report the Chisang Clinic now holds the number on place on a Google search, http://chisangclinic.org/new/

I even arranged to have an ambulance buzz us during the interview (not really, its one on the hazards of recording out an about). 

Due to the length I have split it up into two parts, each will be 35-40 minutes long, good enough to take on a jog.  

Below are a few things mentioned in the podcast. 

You can find the Podcast, and my previous podcasts at

https://itunes.apple.com/au/podcast/downstairs-care-outthere-podcast/id876296199
(I uploaded the episode this morning so hopefully it should be live in the next 12 hours on I tunes, or instantly if your a subscriber)

Thanks for Listening

If your a subscriber then they should be ready to download now, if not, subscribe on I tunes please, and you’ll have access to this great episode.  

Please leave comments here or on the Itunes store, I take feedback seriously so if you want something changed, done or spoken about then let me know. 

CardioPump by  Resqpod

Cardiopump Study from  website

Standard cardiopulmonary resuscitation versus active
compression-decompression cardiopulmonary resuscitation
with augmentation of negative intrathoracic pressure for
out-of-hospital cardiac arrest: a randomised trial

http://www.resqpod.com.au/publications/news/ResQTrial%20Lancet%20Article.pdf

The Paramedic “Tacklebox”


Back of the Ambulance

 


A “burning” plane for the Airport MCI

 

PICHFORK (Pain InCHildren Fentanyl OR Ketamine) , not from the Starship in NZ, from Australia.

http://www.trialsjournal.com/content/14/1/208

Supplied the Ultrasound that Aiden took to Nepal

Sonosite. com

MDA Israel EMS

Mdais. org 

Go download the GOODSAM APP!
Now on Android and IOS; Some reviews and an interview with the creator.
http://lifeinthefastlane.com/techtool-thursday-050-goodsam/
http://emtutorials.com/2014/04/smartphone-activated-medics-goodsam-app-interview-mr-mark-wilson/
https://www.goodsamapp.org/

Stroke Ambulance in Germany
http://www.medgadget.com/2012/06/specialized-stroke-ambulance-features-ceretom-portable-ct-scanner-to-reduce-time-to-treatment.html

Helicopter Heroes
http://en.wikipedia.org/wiki/Helicopter_Heroes

https://www.youtube.com/watch?v=w32PUDL2lb8
By far the greatest video the video of Chris Solomon having and MI and Cardiac arrest during filming for Helicopter Heroes.

 The book Aidan mentioned

http://en.wikipedia.org/wiki/Mountains_Beyond_Mountains

http://www.amazon.com/Mountains-Beyond-Quest-Farmer-Would/dp/0812973011

Liz Crowes AMAZING #SMACCgold talk on  Swearing your way out of a crisis

http://lifeinthefastlane.com/swearing-way-crisis/

You can contact/Read more about Aidan on twitter and his own blog 

@alittlemedic on Twitter
http://littlemedic.org/

All round amazing dude, and he paid for lunch!

I have no financial interests in any of the companies or products spoken about during the podcast 
Aiden has no financial interests in Cardiopump.  

Book Review: With Spirit and Courage; Paul Featherstone and Ian Head

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With Spirit and Courage; Paul Featherstone and Ian Head

Published 2002 by Mac Millan

 

 

I purchased this book on a whim, while trolling the internet for paramedics I came across a copy for sale on E-bay, I figured it would be an interesting read.  I was basically unable to put the book down between shifts, for those who follow me on twitter you may know my girlfriend had to confiscate my copy of “ABC’s of Prehospital Medcine” over the weekend (review forthcoming), this book evoked the same reaction, I had to hide this book down in the garage and read it while pretending to fix the dining room table (a task I am still avoiding).
Starting with young Paul Featherstone the origin story ( every good hero has an origin story)

The book goes through the initial inception/founding of SCAT (ASNSW’s Special Casualty Access Team). The identification of a need to access and treat patients where ever they may be.

training and development are covered and the book touches on the process of selecting and training the SCAT officers to perform in adverse conditions an arduous task from the initial team to the present day (Circa 2002).

But that’s not why you buy the book, no one wants to read about something you could get from a media blurb.

You buy it for the same reason everyone buys Paramedic books. Stories and this book is full of them emotional and inspiring. Throughout the book the tense moves from present to post event, I found this easy to read as it kept everything together in the one paragraph.

A unique feature of the book was the inclusion of significant figures quotations talking on Paul and events in the book. The quotes from his wife would make good reading to the partner of a Paramedic.

It was remarkable to read from a personal stand point, I believe its a book that should be on the required reading for ambulance officers. We spend long enough learning about the How of what we do. This book found me asking myself WHY I do what I do, and providing some answers. I think you’d be well served by giving you time to read this, put down the latest paper on the technical aspects of paramedicine and take some time to examine in yourself, why you do the job, or why you want to do the job.

This is a book about Paul Featherstone’s career, from the Granville Train disaster to plucking rock-fisherman from the water, this book covers all the action man stuff, but takes the time to thank all involved, not a chapter goes by without throwing the spotlight onto someone else.

By far the most compelling part of the book was the written account of the Threadbo rescue (for those non Australian readers info below) the picture below is that iconic image of he moment Diver was pulled from his “concrete tomb” as its described in the book. If you only read one section of the book, it would be the Threadbo section.

I’m delighted with my purchase of this book, if you can find a copy on ebay or in a used book store its an amazing read and you’ll be disappointed when it ends I know I was.
its similar in style to Kelly Grayson’s Life and Death and everything in between which is well worth the read.
Any current Paramedic or Student would get a good deal of enjoyment out of this.
What I think makes this book so appealing is the local aspect, while overseas books are well written. You don’t feel the same affinity that you automatically build with a local biography that you can identity with.

Stuart Diver is released from the Threadbo Landslide site

I was 7 when this all happened, its one of the few iconic moments I remember watching on the evening news, as my parents had hustled me and my brother into the lounge room and told us to be very quiet and just listen.
I was utterly compelled to keep reading through these chapters until the entire journey through the saga was complete.
A today tonight segment on Paul Featherstone upon his retirement, details his vast experience and life;  https://www.youtube.com/watch?v=b2yIeFnDzBw

For overseas readers

The Threadbo Landslide;

http://en.wikipedia.org/wiki/1997_Thredbo_landslide#Screen_adaptation_.22Heroes.27_Mountain.22

 

The Granville Rail Disaster;

http://en.wikipedia.org/wiki/Granville_rail_disaster

 

SMACC GOLD: A Paramedics experience

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I tried to sum it up in a podcast (can be done….. just can’t be done), I’ve probably only captured 40% of the feeling I had.

An Amazing experience, full of Amazing and down to earth people.

NEVER have a been to a conference where speakers so freely interact with the audience.
NEVER have I been to conferecne so open and available to everyone, from experts in their field of medicine to paramedic students, EVERYONE was welcome.

I hope I pronounced everyone’s names right

I made the decision to stay right away from the checklist debate in the podcast…. I don’t want to stoke that fire again!

without further procrastination here’s the podcast:

ITunes(slightly slower to update, new episode may or may not be up, subscribe and it will be automatically delivered when I add it):

https://itunes.apple.com/au/podcast/downstairs-care-outthere-podcast/id876296199

direct feed for those who don’t use I tunes:

http://dscotpodcast.podomatic.com/entry/2014-05-14T23_59_56-07_00

For further reading; 
Alan Batt’s AMAZING Post on SMACCGold, Alan managed to capture the conference without actually being present.
(A huge thanks for permission to link to his post!) If you haven’t seen his site already this is a small example of the quality writing over on Prehosptial Research.

http://prehospitalresearch.eu/?p=2088&doing_wp_cron=1400136508.9596900939941406250000

Podcast now on I-Tunes

Great news, I’ve now managed to get the DSCOT podcast onto I-Tunes, so if you could go over there.

Thanks, I’m currently talking on my Impressions of SMACC GOLD. That episode should be ready soon.

https://itunes.apple.com/au/podcast/downstairs-care-outthere-podcast/id876296199

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