The Final Post

Here are some random things I've learned or observed in Romania:

• Everyone gets fluids - even if it's not indicated by our Aussie guidelines, no worries - give them prophylactically!
• Up to 10 paramedic/SMURD staff at a single patient emergency scene is not uncommon.
• Catheters are a decent replacement for torniquets
• Sharps safety? Ain't nobody got time for that!
• They don't have NPA's here, only OPA's and LMA's
• Vacumats and "Metallica" (scoop stretcher) are hands down the most valuable pieces of equipment to a Romanian paramedic
• People are generally rather surprised we've come all the way from Australia and 95% of initial responses is the exclamation "oh! you have kangaroos" accompanied by mimicing the skip. Hopefully we've shared something more and broadened their understanding and appreciation.
• Jason and I got the record for highest and lowest blood pressures seen. One patient topped it at 254/180, if I recall correctly, and the lowest one was 42/34 or unreadable.
• If a Hungarian speaking Romanian has upset you call them a "vossfay!" but be prepared for a very shocked reaction. "Fossicor"is a less offensive alternative
• Romanian doctors have a practice of wearing dressing gowns if it's a colder day than usual. I never quite figured out why such a wardrobe item was acceptable as professional uniform haha.

SMURD by night

• My favourite Romanian word is: cu placere = you're welcome. It's just so very satisfying to say. The only problem is that I'm always the one saying thankyou, not them, so I didn't get the chance to say it enough. James loved it too so sometimes I have a suspicion that his whole motivation for being polite such as holding the door of a restaurant open for us was so that we'd have to say 'Multsumesc' (thankyou) and he'd get to use the response!
• My favourite Hungarian word is: "Agashigadre!" meaning cheers. In Romania, every enemy can be made a friend or every problem solved by sharing a drink with them! Wine and beer are abundant and affordable :) We have all established that Hungarian is the hardestlanguage in the world. I just found out that our friend Aushi is actualy "Orsi" - I'm so sorry, friend!! It's difficult enough to pronounce but to spell, virtually impossible!

 

Last sunset we saw in Turgu Mures

 One thing I didn't anticipate but a big take-away from the trip was the 6 of us learning off each other: SA has the best student training & experience but the worst chance of a job, yanosh should start his own ECG teacher channel on youtube, VIC has the prettiest most colourful CPG's, and Perth interestingly gives you placement in the NT. Since all of us are at different levels of experience and course progression we learned heaps just by sharing stories.

To top it all off our last morning in Romania we looked out the window of Retro hostel and saw snow falling!! Our last goal of the trip is now ticked off :) Our last morning was also great becasue we were provided with a free breakfast of pancakes & banana, so Tori didn't have to eat bread and cheese for the 25th morning in a row! (P.S. this is a shoutout for Retro Hostel - I'm helping the guy there makes his pancakes world famous!)

The city of Cluj-Napoca from Cetatuia Hill

Tori and I spent half our last day at he beautiful Botanic Gardens

A statue in the Botanic Gardens - just to prove that yes we were in Europe!

Thanks for everything Romania, hope to see you again!

Catchup Post #2 - Training Day

(*Catchup post for Tues 16th Dec*)

I began today with a run along the Mures river- not sure if that kind of thing is very common here but I feel very conspicuous and one of a group of cheeky school boys tried to trip me up! I guess litle boys are the same the world over!
Anyway, back to the project. It was meant to be my RDO but Attila organized for all of us to participate in the second day of the "Basics for Nurses" course. It's a program developed in Hong Kong and this was the first trial run of the training in Romania. With a couple dozen nurses both from here and from Cluj we sped through the theory of intracranial pressure management, CPR, patient communication, and other relevant emergency topics. Yamesh (James) was on the ambulance today and made a bit of a disturbance every time the radio beeped - because with SMURD's incredible response times, you're unlikely to make it onto the Dr's car if you don't act like the call is the gunshot in a 100m dash. After a lunch of gigantic (but strangely topped) pizzas we students formed a group and rotated through practical modules. All the tutors were incredibly helpful and re-structured everything in English for us. We learned about putting in arterial lines, managing patients on CPAP, practiced handovers with the ISBAR tool (which definitely highlighted our need for improvement!), and did some problem-solving and guesswork together as pracs such as tranpsorting a ventilated ICU patient were totally unfamiliar to us.

L-R Mihaela, Jason, Hannah, Tori, Amanda and the Instructor: playing with SimMan  and discussing how to prepare patients for transport in their super awesome training facility

Amanda totally loved her taste of CPAP!

I think I can say that all of us really enjoyed the learning and recap - it was good to feel busy all day for once! Having drinks at the classy Downtown pub with our main man Attila was a good end to the day.

Catchup post #1 - Ice Skating!

(*Catchup post for monday 15/12*)


Monday was a shitty day for most of the world; watching footage of a fatal SMURD helicopter accident on the East coast of Romania put a dampener on dinner discussion, during which we were receiving updates on the Sydney siege. Hearing about the Pakistan school shooting as well just made us acutely conscious of the fragility of human life and appreciative of the integral part we get to  play in restoring human health. We did, after all learn a lot today and are extending our training a lot by being here in another system on the other side of the world.

In the hospital I saw my first arrest and was ready to jump on the chest doing CPR but her heart rhythm became incompatible with life and unfortunately the Dr had to call it. Jason and I did some x-ray analysis and though we at first didn't notice anything unusual we found that there was significant cardiomegaly. I need to master the memory tool for x-ray analysis I think! Since we can't always be involved practically when in Resus, we read patient histories. We saw the unfamiliar term "Bronchopneumonia" and found out that it means disease that is confined by interlobular septa but "interstitial pneumonia" is not as confluent or dense. Another thing we saw was that their glucose measurements here are very different. We pretty much have to divide by 18 to get a number that means anything to us. Our day was full of stroke and pneumonia patients really. This means we saw a lot of the Neuro Assessment team who were checking things like orientations, babinski reflex and unilateral weakness. It was pretty confronting to see the way someone's body changes when they are kept alive by a ventilator just because brain death is not yet verified.

Aushi arrived at the Majestic to meet us for dinner and we tried to think of cheerful things to chat about; one of which was "who was the lunch lady at the cafe today?" We were very grateful that we'd had the nice lady who looks out for us walking into the hospital cafe and then immediately takes over position at the counter calling "don't worry, I help you!". She is really amazing and whenever she works our lunch-ordering is a much smoother experience. Even learning to say the right Romanian prices and pronounce the food (which is labelled) is a big challenge! I'm sure there were other positive things we remembered, but that was a big one!
Aushi announced we were going ice skating for the evening which transformed the sombre atmosphere and not long after we arrived at a winter wonderland where lights and music gave us almost a magic feel. None of us Aussies were particularly adept at the sport so there was an extra thing to point us out as different from everyone else on the rink but we had a great time! Tori and James had a spectacular collision not to mention the million stacks the rest of us had but they were accompanied by a lot of laughs. Yamesh (James) tried to coach us into skating backwards which Tori and Hannah did a remarkable job of but I think our friend Raszvan, a Romanian med student and ambulance volunteer, was amused by my attempts! Yanosh (Jason) persevered through a high degree of pessimism and got out on his own in the end so I think I can say the night was a success!

loved it so much some of us stayed for a second session!

See you again, SMURD!

SMURD logo: for the ED, Ambulance, and Fire

 We had a great last day at the SMURD Emergency Department. We all really want to come back here one day! Tori and myself spent the morning in Yellow Room (Immediate Care) which began quietly but as always, ramped up after a couple hours with patient load increasing to 2-3 beds per bay. Under the guidance of Huni the party animal nurse we honed our cannulation skills and helped where we could amidst the hustle and bustle of green, blue, and orange scrubs. It's the busiest area of ED by far, but the one I've enjoyed most. We got to see Cosmina and Mihai there too, who have been some great mentors! Since there's so many patients in and out there's a lot of different problems; today I learned that a tell-tale sign for patients with liver problems is a blotchy face.
Jason had a pretty good day on the ambulance too with callouts to some short of breath patients and a pedestrian vs train event, in which noone was severely hurt. It doesn't cease to amaze me how Romanians bounce out of so many high acuity transport accidents with comparatively minor adverse health outcomes- it's just miraculous! Of course, in between his jobs Jason was analysing ECG's and sharing discoveries of uncommon rhythms with the rest of us.

VacuMat- great for immobilisation

Resuscitation Scenario

Intubation: video screen of vocal cords and tube being placed in the trachea

In the afternoon Attila took us for some simulation practice in the SMURD training centre. I was introduced to the CT6 splint and applied it to a sim-man just like we have at home. Attila taught us the basics of intubation and we all had a go, aided by some incredible video technology which gives a very clear, otherwise unattainable view of the vocal cords through the procedure. We also ran through a couple of resusciations scenarios and compared protocols. Here in Romania they have actual paddles which you clamp down on the patient to defibrillate, though they are phasing these out to defib pads like we use in Aus.

It was a bit anticlimactic not being able to say goodbye at the end of the day to everyone we'vemet the last few weeks, but then  that's shiftwork. You can never see everyone at once. We did have a cool coincidence though with our taxi home: Daniel, one of the SMURD ambulance driver's we got to know was also the taxi driver who arrived to pick us up tonight and he also happened to be wearing his Aussie jumper today!

Hannah, Attila, Tori, Me: saying bye! :(

Bye SMURD!!

Excursion Day (Wednesday)

Mures County Dispatch Centre

This morning I ran in the forest up the hill behind us again and struggled against a lot of boggy mud; even running on cobblestones isn't exactly smooth travelling compared to the footpaths at home! After that the hostel breakfast lady surprised us with cereal instead of bread ham and cheese!

Attila, our new favourite person, led us to the middle of town where we found the Mures County Emergency Dispatch Centre. The setup was very impressive and a completely new experience for most of us who have never got to be on the other side of  emergency calls. We entered a large room and the first thing we saw was a wall of massive video screens. These provided constant monitoring of different locations in the city and footage zooming in up to 1km! Police, Fire services and Medical Emergency services work together in a team of 5 operators who answer all calls and a second team of 5 experts and chiefs who determine priority and resource allocation. Only 10 people work in this single room dispatch centre and they receive 2400 calls a day but a whopping 80% of them are fake! We asked the cause and were told that many teenagers aren't educated on emergency numbers and call up for fun.

Dispatch Centre

Mures County: Targu Mures is in the middle and all the yellow dots are evenly spaced emergency bases; this helps with very good response times

Ambulance jobs make up the majority of the real calls so it's a pretty important service! The calls are designated as Priority Red (response time 8min), Priority Yellow (RT 15min) and Priority Green (RT 30min). We were very surprised that ED doctors even take shifts in the Dispatch centre as the 'medical expert'. The level of cross-training here in Romania is incredible. These doctors work rotating shifts between the SMURD helicopter, in all the different Emergency Department sections, in the ambulance, and dispatch. It makes for a very fluid system with great communication and understanding! Dr Arafad who started up the SMURD program was the mastermind behind this system and Mures County has the best in Romania! The Chief Manager of Dispatch gave us a complete history lesson and gave up hours of his time to answer our million questions! Like we experience with many Romanians, he apologised profusely for his poor English and then proceded to speak in near perfect English the whole morning, and tried to match our humour with cracking a couple of not-quite-appropriate-for-here jokes with us! We got some live entertainment at the end of our visit: we saw footage of a car parking inappropriately, a politia vehicle was immediately dispatched and then moments later blinking sirens appeared on the screen and we saw the offending driver of the illegally parked car hurriedly rush back in and drive off as the police car began pursuit!

SMURD Fire Station

Pompierii = fire fighting service

Obtaining entrance to the fire station required signed paperwork and passports but Attila sorted all that out for us to the immense excitement of Hannah and Tori especially, who are avid fans of "Chicago Fire". This was the centre for the paramedics base, fire fighter accomodation and training, and specialised emergency vehicles. We saw the "Noua Nascuti Ambulance" (for neonates), a multi-victim transport truck, a chemical retardant vehicle, special emergency vehicle for bomb incidents, and a snow-traverser with caterpillar wheels that could also float and had a stretcher in the back. SMURD is very well equipped and in the event of a major catastrophe emergency staff are very quickly mobilised since all staff carry a radio on their person 24/7 in 6-month rotations!! We couldn't believe it but Attila, an ED & ambulance nurse said it is fine for him.
Attila made sure we had a traditional Hungarian lunch (because "none of this pizza!") which for me meant stuffed cabbage rolls and ribs. There's some pretty good dishes here really but cabbage is the closest we get to vegies!

They can elevate their stretcher beds!

Caterpillar car for snow and water

Silver chemical retardant vehicle

Multi casualty transport vehicle

Since it's our last few nights we are cranking up the party spirit; this meant drinks at the downtown pub with Attila (where they sell non alcoholic beer!). Some of us had dessert at 2am over vigorous discussion about the events back home and the #illridewithyoucampaign. Seriously loving spending time with these 5 great people!!

Weekend adventures

Typical street corner architecture

Sighisoara Clock Tower

Saturday: Castle tour
On the weekend we visited the major tourist site in Transylvania: Dracula's castle. We also fulfilled our goal of seeing snow! The 6 of us all piled into a taxi with Arpad coming along to facilitate communication with the driver - a pretty essential component to having a successful day! All morning he sat in the front seat and kept offering us to try his cooled down mulled wine; we said it was too early but we finally gave in and really enjoyed the cinnamon flavour of the wine his friends made. We got very excited with our first glympses of snow on the side of the road and rushed out at the petrol station to get a better look but absolutely froze in -5C weather! The first stop on our historical tour was Sighisoara where there is a beautiful old clock tower and ancient citadel, as well as a sculpture of Vlad the Impaler who is the character becoming famous through the "Dracula" adaptation. Hannah and James became very good friends with a little dog whom Hannah named "Siggy" there.

A couple hours north of Turgu Mures we found Bran Castle (Dracula's) and had a cool tour of the 600yr old fortress. We tried out the famous Hungarian "chimney cake" which is a 50cm long cylindrical pastry that is traditionally flavoured with sugar and vanilla. Some of us also tested out the frozen lake and made a few snowballs. At the base of the castle we found ourselves in souvenir heaven, or something like that: there must have been at least 50 stalls set up, all competing for of the  traditional hand-painted Horezu pottery, traditional costumes, furry hats and all kinds of Dracula themed items.

Our last stop was Brasov which again, blew us away with it's christmas festivities. The centre of the city was decked out with sparkling lights and reindeer and we walked under a complete canopy of lights with christmas carols ringing in our ears. From there we could see another very old castle in the surrounding mountains; the sign reminded of us Hollywood!

First sight of snow!!

Bran Castle = "Dracula's Castle"

inside the castle

Arpad, myself, Hannah, Amanda, Jason, James, Tori

This lake was completely frozen!

Hungarian Lunch

After braving such cold weather we stayed in for the night and managed to navigate our way through a Hungarian/sign-language conversation with the hostel receptionist who organised delivery pizza. It was the perfect thing after a big day but I can tell you it's only in Romania one orders a vegetarian pizza and finds the top 2 ingredients are peas and corn!

Amanda & I enjoying the lights of Brasov

****

Sunday we spent sleeping in and enjoying a brunch at Negro's which produces a cappucino most resemblant of what we're used to in Australia and walking around our temporary city home. Amanda, Jason, Tori, Hannah and I walked up to the Mures River which has a nice walking track along either side and a suspension bridge. On our way back we found a lake that had frozen over!!

Probably not quite enough to skate on yet though: the surface couldn't take more than a 5cm-diameter stone but we had fun skimming them across nevertheless. The Irish Pub 500m walk from our hostel provided us with a hearty dinner.

it's a different world.