So, Monday was broken up into two parts: Trauma calls in the morning, medical calls in the afternoon. Each student had to do one full call (~40 minutes) of each.
After the trauma call, I was reasonably certain I’d mucked it up royally.
My “patient” was a pedestrian struck by a car going 60kph, with bilateral femur fractures, potential spinal problems, decreased level of consciousness, and severe shock. After I finished the primary assessment and declared her rapid transport (ie, we go straight to the hospital, rather than finishing off the secondary assessment on scene) the instructor asks why she’s rapid transport. Uh… why ISN’T she rapid transport? Hah. I start rattling off reasons, and he interrupts me with “ok, ok! Good.”
So, we get her strapped in. I was talking to myself out loud a fair amount, which turned out to be pretty good idea as it saved me from having to defend my actions. Despite being a spinal patient, I wanted to use the clamshell stretcher, instead of the spineboard. Since she had very painful bilateral femur fractures, rolling her up onto her side to get the spineboard under her would have just caused more pain (and potentially further injury) than necessary. So, we put a spinal collar on her, got the clamshell under her, and went off to the ambulance.
Here’s the part I screwed up, and it was mostly due to being flustered at the additional questions (and some leftover frustration from an equipment problem I’d had — when the velcro on the zap straps don’t stick, I get seriously pissed off. I really need to work on that.) As we’re wheeling the stretcher to the “ambulance” (read: two feet away from where we started) he asks me how I’m moving the oxygen over.
…
“Uh… carrying it alongside the stretcher?”
“Are you sure?”
“Um. Okay. You know, forget it, I’m just going to leave it off for a second and we’ll put it back on as soon as we get in the ambulance, since it’s right here.” DANGER WILL ROBINSON!
“Really?”
“Yeah, it’s only a few seconds.” NO! YOU IDIOT! STOP! PATIENT IS IN SEVERE SHOCK! NEEDS OXYGEN!
“Oookay.”
Yeah, the first response would have been just fine. Carrying it, or having one of my bystanders carry it would have been fine. Often, you can put it on the stretcher with them, but the way she was strapped in didn’t leave any extra space… bah. Ok, so that was my Really Stupid Brain Fart moment.
My biggest worry, and my reason for being completely stressed out the rest of the day: I was pretty sure I’d mucked up the spinal precautions. At the end of the call, my instructor asks me to come down to the bottom of the stretcher and take a look at my patient’s neck alignment… and it’s TOTALLY off. The collar’s gone crooked, and her head’s out of alignment. Shit, fuck, piss, bugger all. I should have taped her head down to the clamshell. Sadly, while we’d been made aware of the ability to use the clamshell with spinal patients, we really hadn’t practiced it much, as the spineboard is usually preferable (just not with bilateral femur fractures.) I’d simply put sandbags (our student sandbags are actually just water-filled bags dubbed by one of my classmates as “funbags”.) on either side of her head to hold it.
At this point, I was sure I’d failed it. I mean, quadriplegia is forever, y’know?
Turns out, in a “real life” situation, my sandbags would be real sandbags, and would have held her head still just fine. So, while I did get docked a little for not fully stabilizing her head (other alternates to taping her head down would have been to have someone holding spinal while she was being moved) it wasn’t a failing point. Phew. He even said that taping down her head would have been a bit of a waste of time, considering the several other life-threatening issues we had going on. Go me. Nice to know that the 5 hours of panic were over something that I wasn’t really being marked down on at all.
My medical call was ridiculously simple. Elderly woman with cardiac chest pain. Rapid transport (proud of myself: I had her loaded in the ambulance within 4 minutes of starting the call). Then nitro, ASA, entonox… I know that stuff like the back of my hand. The evaluator even praised my bedside manner and I passed that one with flying colors.
Also got the results of my written back — 91% (aka, 109/120), and even had 5 minutes to go over the ones I got wrong and check what the correct answer was — that’s handy. At least 3 of the questions I got wrong were just me being a dumbass, and a few more were so bloody obscure I don’t think too many people got them right. So, good on me there.
Now, I need to apply at EMA Licensing ASAP so I can do it all over again for them before I forget everything.
And, as a bit of a side note… huge, major, incredible, awesome thanks to Nick for celebrating with me, and not getting tired of me rambling on incessantly about sager splints and entonox protocols and the constant exclamations of of “omg, I passed!” and generally being giddy and crazy and letting the stress of the last three weeks escape. You mean the world to me.
Yay for you! Very, very, very spiff.