Ambulance here I come!!! (Thursday)

First of all, to set the scene, BEST DAY ever :D It was one of those times when you find yourself smiling at random points of the day for no particular reason and feel silly once you realise and bite your lip to stop in case the people around you notice and think you're a strange maniac (maybe they're not far from the truth, but shhhh!).
After running down the street to halt our impatient taxi to the hospital, and then discovering it was the wrong one, we got to SMURD and found we had spare time to watch the helicopter come out of the shed and take off - a moment of great excitement for all three of us and especially Jason whose ambitions revolve around health helicopters.

 After that Mihaila, one of the really friendly nurse/educator/in-charge/paramedic workers introduced me to Marian, the resident Dr on ambulance duty. Dr Marian (male)'s english speaking colleagues gave me full access to check out all the ambulance vehicles and their equipment and before long we had a job!

Inside the SMURD special events ambulance

(L-R) Special ambulances, then 3 Dr ambulance jeeps which function in a MICA-type role

We wound up and down many hills; such a lengthy scenic route almost had me fooled that we were just going along for a ride to critique our new driver's skills, but no, then we reversed and rattled up a rocky road and aftera brief exchange of shouts and vigorous arm gestures with a pedestrian we grinded to a stop in front of a large gate. Another SMURD vehicle was already on scene and upstairs in the nursing home we found an elderly man whose problem was "not speaking" and query stroke. We loaded him up even though a paramedic explained to me "he's probably faking". Turned out his main problem was hypertension (225/70) which was treated ineffectively with Endopril. We handed him over to the yellow section "Immediate Care" and not sure what happened next but my colleagues Jason and Hannah told me later the first intervention done was to put him on a Normal Saline drip (because here, fluids for everyone!) I stuck close to the red suits and not half an hour later off I went in the Intensive Care Therapy Ambulance, which is a large unit that to me seemed almost a mini mobile hospital. The facility was well used when we got our next patient in the back and all hands were on deck to preserve what remained of life: a c-spine collar was applied, clothing layers cut off for access, sedation and anesthesia given and the patient intubated to rescue the otherwise inevitable collapse of his airway, and the ventilator was set up. My role was to observe and do assistant jobs like hold syringes. The patient circumstances was a hanging - in the loft of a gypsy backyard barn. Extrication was interesting: it involved an impressive vacumat device, climbing ladders, and lots of strong hands. Hours later I am still finding remnants of straw in my hair.

In the back of the Intensive Care Therapy Ambulance - treating a patient on a ventilator (above)

Offloading at SMURD Emergency Department

Later Jason reported to me that the patient was in decerebrate posturing. It was very fulfilling to hear the continuum of the patient's care and I realised this is a unique privilege I won't always get to experience as I move forward into a single field: paramedicine OR nursing. I do wish I lived in a world where I could use both my degrees simultaneously. But then maybe I could - if I relocate to Romania! Here the ambulance crew includes a doctor, a nurse, a paramedic, plus or minus a volunteer, and the doctors and nurses rotate through ward and ambulance shifts.

Oana showed me SMURD's specialised Neonatal Intensive Care Ambulance:

Incubator

Thermomat for resuscitation

with the "Noua Nascuti" ambulance

The remainder of my day was spent hanging out with the paramedics of Turgu Mures at the fire station and doing trips between base and hospital for coverage. Those were a fun few hours. I learned to count to 10 in Romanian and discovered some more Romanian foods that I don't like (ask me about bean-bag pasta!) and some that I do, refined my technique of cracking open sunflower seed shells in my teeth, and told a very new acquaintance 'te iubesc' (i love you) because it just popped into my head when i was mentally searching for "I love Romania". Gotta love the awkward and amusing moments that come with language barriers!

My colleagues had, as always, an interesting and amusing day in the hospital. After seeing a nurse almost force tablets into a barely conscious patient's ajar mouth, Hannah exclaims:"Jason, in this country you just have to laugh, because otherwise you'll cry all the time". One can look at certain standards and become extremely critical or one can look at the context and put things into place and appreciate the greater good that is being accomplished through SMURD. Jason and Hannah also got to explore the SMURD helicopter and meet the pilots today. Apparently there's a very good simulation facility in the air rescue base so hopefully the 6 of us can all spend a day doing some quality practice in there.

I just can't believe what an interesting experience today was. Climbing up into the loft of a gypsy barn and getting covered in straw, mud and blood. Now as I Sit here we sip glasses of rose and chocolate and laugh about our crazy days and love the privilege we have to be here :)

Chapsczey, Me, Ellerd, Oana, and a volunteer med student: great guys to spend a day with!!

**To my SES and paramedic friends, I found out that here it is the firefighters ("Pompierii") alone that extricate patients from being trapped in cars. Up to 10 paramedic/SMURD staff at a scene is not uncommon. Sharps safety is an issue that pops up every day without fail. Their ambulance kits don't have NPA's, only oropharyngeal airways. I haven't seen a vacumat in use in Vic, but this device is full of polystyrene balls which have air sucked out of them after the mat is strapped firmly to the patient; the mat then acts essentially as an immobiliser, taking the shape of the patient and is fantastic for moving them semi-comfortably out of awkward places.