A Day In The Life Of A South African Paramedic

How was your day and how does this compare to a day in the life of a South African Paramedic? The Road Safety & Arrive Alive Blog asked a Paramedic from Netcare 911 to keep a diary for us:
Work starts at 06h30, so the alarm on the cell phone wakes you up at 05h00 hours so you can get ready for work. You get up, run through the Sss, s…, shave, shower and shampoo (what little hair you have left). Get dressed and have a quick breakfast before heading out the door and off to work.

On the way to work you think about the possibilities of the day that lies ahead. How many people will be relying on you before the end of the day?

You try to arrive at work 20 minutes before shift handover. This gives you a chance to check your vehicle and equipment, to ensure that everything is working and in its place, before your first call comes in. The response car then gets pulled into the wash bay and gets washed. Taking pride in oneself and ones vehicle and equipment is of utmost importance. Peoples lives are at stake and none of these can fail to operate correctly during those times of need. You then head into the kitchen and make some coffee to get yourself into the swing of things for the day.

You spend some time listening to the accounts of the calls that the nightshift crews have experienced. They had a busy night and are all set to go home and get some much needed sleep.

Ensuring that the base is operational and that all the administration work has been completed is next on the agenda. The stock count has just been started when the cell phone vibrates and rings in your pocket with the first call of the day.

A bus has lost control on the highway and been involved in an accident. You drop everything and get into your response car, quickly punching the address into the GPS to get you to the scene as quickly as possible.

It is rush hour traffic and the frustration of maneuvering your vehicle through the traffic, that ride in the emergency lane or just will not pull over to let you pass, is part and parcel of response driving. With adrenaline coursing through your veins you wonder what you will be faced with when you arrive at the scene. As you approach the scene more information is relayed to you via the control room. It is a single vehicle accident and the bus has gone off a bridge and landed up on the street approximately 20 meters below. Stopping briefly on the bridge you can see the bus lying below you. Quickly the decision is made to drive to the street below so that you have all the necessary equipment with you that you may need. Arriving on the scene you check the time and see that it has taken you all of 10 minutes to cover the 13 kilometers to the incident.

Doing a quick assessment you determine that the driver was alone in the bus. You silently say a quick prayer to yourself, thinking of what could have been waiting if the bus had been full. First ensuring that the bus is safe to enter, you go in through a broken window, only to discover that the driver has been fatally injured.

The necessary authorities are notified and all the relevant documentation and administration completed.

Heading back to base to go and complete the stock order which you barely got started, the phone in your pocket starts ringing once again. An elderly lady at home has not been able to get out of bed due to a painful back.

With the address in the GPS you head off through the traffic which has now started to thin out a little. Arriving at the call address you are met outside by a very worried and perturbed husband. Reassuring the gentleman you start obtaining a history as to what happened. His wife woke up during the night with extreme back pain and has been unable to move since. You find the patient lying on her side in bed with her face racked with pain. While waiting for the ambulance to arrive you provide your patient with analgesia and a muscle relaxant and by the time the ambulance gets there you are able to move her with no discomfort at all. The stretcher is not able to fit in the house so you carry the patient out secured to a disconnecting “scoop” stretcher. The patient is then taken off to hospital where you hand her over to the accepting medical officer.

You complete your Patient Report Form (PRF) and then head off back to base once again. You arrive back at base and quickly restock your bag to ensure that you are ready for the next call. It is now 10h30 and you finish off the required stock order to ensure that there will be enough stock for all the vehicles operating out of the base.

You make yourself a cup of tea and sitting down to do some quality assurance checks on the submitted PRF’s the phone rings again. Taking a quick sip of tea you head out to the car and punch in the address. The call is an industrial accident, a lift technician was doing repair to the mechanism on the top of a lift which was stuck on the eighth floor. Something went horribly wrong and the lift collapsed to the ground floor breaking up into twisted bits of steel and metal on the way down.

The badly battered lift is made secure so that it is safe for you to gain entry to the patient who is lying in a heap of twisted metal at the bottom of the lift shaft. With your protective gear in place, helmet, gloves and head torch you cautiously gain access to the patient. He is still alive but has a severely decreased level of consciousness; the suspected cause is a severe head injury. He is going to need an advanced airway, which means that a tube will have to be put down his throat so that we can assist him with his respirations. In order to achieve this he would have to be sedated, which means that intravenous (IV) access would have to be obtained.

After a quick check it is learned that all the patient’s limbs are fractured. Space is extremely limited and speed is required to get the patient to definitive care. An IV is established in the patient’s neck and then the patient is intubated. With as little movement as possible, especially to the patient’s spine, the patient is immobilised on a rigid plastic board, spine board, and slowly lifted out of the lift shaft. All this time the patient’s respirations are assisted with the help of a bag valve device.

Once out of the shaft the patient is quickly loaded into a waiting ambulance and rushed through to hospital where after stabilization will be taken straight to theatre. After handing the patient over equipment is quickly and thoroughly washed and sterilized to ensure that it is ready for the next call. Paperwork and administration is completed and then you make your way back to base again to restock your bag. 

It is now after 13h00 and the rumble in your stomach is letting you know that you have not had anything to eat the whole morning. You meet up with some colleagues at a popular fast food eatery. The waitress has barely had chance to take your order when the cell phone starts ringing again.

This time it’s a call that all Paramedics hate. A child is involved. A nine year old child has ended up in an unprotected swimming pool and has believed to have drowned. With these calls one seems to be driven to arrive on scene faster than normal. Even if you do not have children of your own there is an element of innocence that makes these calls very different.

You arrive on scene to find what appears to be a lifeless nine year old boy lying on the grass next to the swimming pool. It is quickly established that the child is not breathing and does not have a pulse. A full resuscitation is initiated and miraculously a pulse and spontaneous breathing returns. The patient is quickly packaged and taken through to hospital for definitive treatment. It now remains to be seen whether the child will survive this ordeal. There are so many complications that can occur post resuscitation.

As is done after every call the equipment is cleaned and jump bags restocked. All the required paperwork is completed and submitted before the next call comes in.

It is now approaching 14h00 and you stop and a garage to pick up a life saving snack to eat. Your stomach is about to revolt and you can’t seem to force the pie down quickly enough.

You have barely finished swallowing when the next call comes in. A pedestrian is knocked down in a hit and run. Battling through the afternoon traffic you arrive at the call destination to find that there is no incident. You radio through to the control room, requesting that they phone the caller back to confirm the address. They are unable to get hold of the caller and it looks as though this was a crank call. This is extremely infuriating as people don’t seem to understand that while you are chasing a ghost around, someone else may be needing your help at the same time.

The afternoon seems to slow down. This gives you a chance to catch up on the administration of the base and to ensure that there are no problems with the vehicles and the day to day running of the base. There are always problems to be sorted out and all staff have issues, no matter how big or small, that need to be addressed and taken care of.

Then the phone rings again, this time it’s a motor vehicle accident on the highway. A mini bus versus a car!

Fighting your way through the traffic wondering to yourself how many patients are you going to be dealing with when you arrive on scene?

As you arrive on scene you notice that the mini bus has rolled. In total you have 16 patients on scene. There are 12 patients from the mini bus and four from the car. Four of the patients are in a critical condition. You notify the control room to dispatch further resources and then start to triage the patients according to the severity of their injuries.

The patients that require immediate intervention are dealt with first and as resources arrive they are delegated to assist with other patients. In a mass casualty incident such as this some tough decisions need to be made. It is not always easy to decide whether a patient is viable or non-viable.

The decision is made to air lift a patient that is still entrapped in the mini bus to hospital and the control room is contacted to get the helicopter dispatched. Working closely with the traffic authorities the highway is closed down in order to provide a safe landing zone for the helicopter.

The patient is then extricated from the vehicle using the “jaws of life” and treated and packaged so that when the helicopter arrives he can be handed over to the flight crew and removed to hospital as quickly as possible.

Patients are treated and removed to hospital from the scene until finally everyone has been treated and transported.

The scene is then handed over to the traffic authorities who ensure that it is cleaned up and to do all the necessary investigations.

After handing the patients over at hospital, completing all the required administration and cleaning of equipment it is nearly time to hand over to your colleagues that will be taking over for the night shift.

It has been another busy tiring day and you can’t wait to get home to spend some time with your family and to unwind from the days events.

You hand your vehicle over to the night shift Paramedic and while driving home you reflect on the calls you had for the day. You remind yourself to do a follow up, on the condition of the child that nearly drowned, during the course of the next day.

Arriving at home you put everything out of your mind to spend time with the family and to take in what their day has been like.

As you lie in bed waiting to fall asleep you reflect on the calls that you did and wonder what the shift tomorrow has in store for you.

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The Road Safety & Arrive Alive Blog would like to express a word of appreciation to the paramedic for sharing his experiences. May this provide us with more insight into this important occupation and may we:

* Respect and treasure our Paramedics
* Allow them the time and space to perform their duties
* Drive and behave as responsible citizens so that we don’t provide them with additional trauma to deal with!!