Donnchadha DB
@DonnchadhaD
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PHECC registered Paramedic in 🇮🇪. Studying @UL , Working as EMT 🇬🇧. All views are my own. Interested in education. 21 y/o
Manchester, England
Joined January 2014
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Pinned Tweet
I am officially a fully qualified
@PHECC
#Paramedic
Today is such an exciting day for me, I have wanted this piece of paper since I was 14 years old and now here it is.
What’s next for me now?
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The NHS pay really is a joke, I’ll probs delete this tweet but here we go.
If I spend 30mins sitting with a family giving them the worst news of their lives that is valued by the NHS at £6.50
If I spend 1hr trying to keep someone who is dying alive that’s £13 for my efforts…
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Few weeks ago we walked into RAU and my crewmate said to me “Jesus that guy looks really unwell I’d bed his sats are in the 70s” the ED ACP overheard and said “nah he’s fine I was just in there” about 5mins later a student nurse shouted for help from inside the room, Sister and
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I’ve been getting frustrated recently with the info we give in handover vs what’s written down and passed to the doctor.
I will show an ECG with concerning peaked T waves and they type “crew concerned with ECG”
I might say rebound mc burneys point tenderness and they write “abdo
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Had my final shift last night before I take the summer off on a career break
This job slowly wears you down and I decided I wanted to try and be a normal 21yo for one final summer
Starting this job at 19 was crazy, to be only 21 and have seen so much
I’m excited for this break
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@Carla_xiv
Like it’s insanity when you actually break it down like this, I think even the general public would agree that getting payed £24 for that isn’t even half what it’s worth!
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Again I am generally pro ACPs
But
I want to see the OOH GP referral acceptance rates pre and post ACP introduction
I would guess my rates are
Referring to GP 75% acceptance
Referral to ACP 25% acceptance
I’m getting so sick of this
Taking old ppl to hospital HAS RISKS!!!
And
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A question for police officers.
When ye are having a scuffle on the floor with our pt, be that due to assault or Section 136 or some other reason
Do ye want us ambos to get down and give ye a hand or do we just get in the way?
Its a discussion were having on station recently
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@DrOShabir
I’ve always wondered if ED drs ever read our notes cuz I spend so long trying to make them good and useful 😂😂😂
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#MedTwitter
I think all ED staff should have to do a minimum of 3 weeks placement on normal ambulances
All pre hospital staff have to do ED to “understand what care pts get after we drop them off”
What about understanding what we do before they get dropped off?
#iminamoodtonight
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For the loved ones of ambulance/police always remember when they say “I did a hanging down there” or “an RTC over there”
They might laugh it off but each and every one of those is a traumatic incident they’ve experienced and there’s probs many more they don’t point out.
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Everyone seems to be saying “I would want an expert not a paramedic”
Is this person not an expert?
5-6 years of Uni, many years road and air experience, passed all exams and competencies to be PHEM consultant, done many PH RSI under supervision of Dr and signed off as safe
What
Plan by
@swasFT
to introduce pre-hospital anaesthesia air-ambulance teams without a doctor on board. Is this appropriate? We want to start this discussion now.
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I Wonder if all frontline
#ambulance
staff got assessed for ADHD how many would actually have it.
My best guess would be >60% I think almost every crewmate I’ve worked with has shown just a few too many symptoms.
I got Dx when I was 8, feels like it’s everywhere in our field.
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I think when Police request Ambulance they should get a minimum of a Cat2 response
And when Ambo request Police we should get a min of a Grade 2
How many hours are wasted every day by one service waiting for the other?
I’ve been to police waiting 3-4hrs and I’ve waited the same
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It is such a privilege as
#ambulance
crews to have almost infinite time with patients. Just spent 1.5hrs talking to a pt before we really knew why we were called. Pt said he were the first ppl to take the time to talk to him, we explained how lucky we are to not have time limits
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Any Paramedics/Nurses etc out there that want to get better at reading ECGs I would 100% recommend the MedMastery yellow belt ECG course.
(Blue&Black belt too if u want more)
It’s amazing at teaching there’s so many things I was taught but didn’t quite understand until now.
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I’ve tried to stay away from the PA debate but this is crazy.
The low HR with no meds alone should prompt an ECG
Sending someone home for BP monitoring with a symptomatic postural drop wtf!! That’s one way to cause a TBI
No increase HR on exertion and still some aren’t
Attempted to hide identities as much as pos. Sent this and found it too damning not to share.
PT presents around 3pm. A doctor doesn’t appear to be contacted for support or help, and instead a Facebook group of PAs (PAAUK) consulted instead. PT in HB sent to a&e not until 6pm.
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I wonder are amb crews the only ppl to experience:
With MH pts asking “are the voices telling you to harm me?”
They say “yes they’re saying to kill you”Then you just have to say okay and be locked in a metal box with them for 20+ mins
Its crazy what we have to just put up with 😂
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IMO
There is much more pressing things that need to be fixed before we concentrate on HEMS
Having paramedics with a 3-4 year degree unable to cannulate or provide “basic” lifesaving drugs needs to be fixed first
No IV fluids
No furosemide
No atropine
No adv pain relief
No abx
Concerns raised that Irish emergency medicine model is 'failing' severely ill and injured people (via
@thejournal_ie
)
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I often wonder how many things are passed from paramedic to paramedic through mentorship that aren’t based on any real evidence.
Classic eg is 4x 2.5mg morphine (in adv adult)
Or no taking BP on arm that has had breast CA lymph node removal
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Just to preface I think GPs are great in general and most have immense knowledge
BUT
PLEASE learn how to use O2!!
1. You cannot have less than 12L on NRB mask or u are suffocating ur pt
2. Please learn how to open the tank valve on the side
It’s become worryingly common!!!
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I had a great Uni day today on Neurophysiology and TBI by a prof of physiology and an ED consultant.
Both stressed that Hypotension in TBI is a major factor in secondary brain injury.
I just want to put it out there for any paras that didn’t know or have forgotten that <110SBP
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A few weeks ago one of my friends was looking at a photo of me and said
“Oh is this from before you joined the ambulance service” and I said
“yeah how did you know”
and they said
“Oh you just look so… idk healthy?”
That’s what working for the ambulance service does to you😞
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I think this is a problem that’s going to worsen and worsen. PHEM doctors are becoming the pre hospital critical care staff and paramedics are being left behind to do urgent care and GP work. Paramedics should have the ability to be the top in their field and not just assist docs
Anyone know why there’s a bunch of PHEM/HEMS placement opportunities for medical students but absolutely zero that I can find for student paramedics?
I’ve applied to a handful over the last two years and every single time been told it’s medical students only.
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Just had a person recognize me in the street and give me a big hug and say thank you initiating end of life meds for his father in law and that him and his wife are forever grateful.
Feeling like a good cry now, sometimes we really do make a difference.
RIP
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Recently had a job where the pt said their daughter was a Dr and the daughter rang her after a min my crewmate asked if she wanted to speak to him. The pt handed the phone over and immediately heard “why would I want to speak to a paramedic”
Where’s the interprofessional respect
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@Interestbroadly
Yeah that seems to be a common thing that’s said, but also if you see police struggling to control and you just stand there and watch them get kicked and punched it feels pretty shit
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I sometimes wonder if GPs were able to go back to 20-30min appointments would it actually take strain off themselves.
This is a long post but I think important one
We often go to pts that call their GP every day with problems and other things when really all they need is a
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@IamJayTulk
My crewmate got assaulted beside me with police present and they were struggling to get control of him on the floor so me and a nurse grabbed a wrist each while they got legs and handcuffs but I’ve only helped that once.
Just feels shit seeing pol get assaulted and not helping
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Forgive me for being naïve but why can’t Paramedics administer ketamine not only is it an extremely useful pain relief but is also shown to be very beneficial to pts with ABD.
Even if you had to speak to an AP/Dr over the phone prior to admin. Also include IM route in the PGD.
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Just to put it into perspective there is >32,000 registered paramedics in the UK
Yet there is only 3 paramedics on the FPHC register for consultant practitioners
That’s a 10,000:1 ratio
And yet people still say these people aren’t experts in their field
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I had a pt in early 20’s who took ≈ 100 paracetamol in <1hr (they had the US bottle of 500 tablets)
They laughed and said to friends “we will laugh about this in a few weeks”
I’m usually very chill but not in this case, I was like you clearly don’t understand the amount of
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I wonder is it classed as traitorous to be working for the crown on st. Patrick’s day☘️🇮🇪😂😂😂
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Sometimes I start to think “hmmm I’m actually starting to know quite a lot about paramedicine” and then I open twitter see some post I barely even understand and realize my knowledge just about scrapes the surface, then idk how to feel
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Anyone else find the feeling of getting into the cab of the bus after walking out of resus after a big job so strange?
Like just had sooo much adrenaline running through you for like an hour and your just like welp… now what?
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It is still scary for some clinicians to encourage self extrication especially when there is vertebral pain but I think at this point we all know it’s the right thing to do.
Please be a good advocate for your patients if there’s more “old school” clinicians insisting on old ways
Following motor vehicle collision all patients should be encouraged to self-extricate asap. If not possible, need to create minimum safe space for self/rescuer extrication w/o delay
#FPHC2023
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I’ve been having some thoughts of applying to be an RAF medic recently, the thoughts of actually being able to do interventions that clearly save people’s lives and making friends along the way is pulling me in.
Ahhhh idk maybe it’s just my ADHD getting bored of my day job
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@HarryTtweets
I have to disagree here In my experience amb crews are too risk averse and take ppl to hospital just because,
There’s so much research out there that proves that unnecessary admissions can be detrimental to elderly ppls health.
If we had enough GPs amb would all be out of jobs
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This day 2 years ago I had a placement in an orthopedic clinic with an SpR and a 3rd year GEM student and the SpR said “idk what they teach paras so I’m just gonna ask you similar questions”
Boy was I so out of my depth but I *think* I managed to hold my own but it was so
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Does anyone else just get random anxiety about pts presenting with life threatening conditions that you can’t treat yourself
Today I just got hit with a wave of anxiety about what if I had a pt with an aortic aneurysm that tears during assessment
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So glad the guidelines are finally catching up, I’ve never put a collar on someone but it’s still a bit scary going against guidelines even if you know it’s right.
Now
@PHECC
need to follow suit I’ve seen too many of the old techniques used recently when I’m at home
JRCALC has already adopted some of the principles of the EXIT strategy so ambulance clinicians should feel empowered to self extricate.
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@simontutt88
SDEC accept nothing, I have given up on attempting referrals
D&V? nope could be infectious
Increased confusion? nope could go wandering
Chest pain? Nope don’t do CP
Collapse - orthostatic hypotension? Nope won’t be able to mobilize so unsafe
After 12pm? nope we close at 5 we
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@Malcmacgregor
I completely get your points here and it actually does make a bit more sense now.
But someone with rebound mc burney point tenderness might need a Rats vs someone with general abdo pain might enter normal system.
Same goes for some of the other things.
Idk maybe I’m just
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I find the idea of ECA/Paramedic crewing a bit wild as someone who has never experienced it.
Where I work if I’m attending then I’m attending and my crewmate is assisting and vice versa (unless big big job then we swap)
Obv my crewmate can override my treatment plan if they feel
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Had a pt in a nursing home few weeks ago and a GP came in for rounds I saw him and thought it would be good to get his opinion and I looked at him and said “can I talk to you about this pt”
This man shewed me away!!
like that hand sign your mom would do when on the phone 🤯🤯
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Sorry long post - if reading please read it all.
I agree with this nurses and paramedics are very different roles, there is 100% a place for PH nurses in nursing roles and I even think there’s a place for PH nurses with paramedic scope but it would take atleast 12months
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I will forever hate that I did my course in COVID, we never got to do anything like this and we missed out so much!
That and online teaching was a joke when I did it!
Largest ever immersive simulation thrusts UL students into emergency situation
The simulation was designed to prepare both students & professionals for a multi-casualty, major incident where a response is required across multiple agencies
#StudyatUL
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I believe this is due to human factors,
Paras don’t want it on their conscience if anything was to go wrong running a Ped arrest
It’s also much easier to grab a baby and go to the ambo than it is an adult
It takes a strong para to go against their instincts and stay on scene
90% of pediatric OHCA are rushed off scene too early.
Great presentation today by Chief William Cebulskie who won the award for the best pediatric presentation at the 2024
@NAEMSP
Annual Conference.
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Is there a place for the average paramedic to be trained in US guided IV lines now that there is affordable portable US?
Not everyone can have an IO due to pain if they’re GCS15
Would it just be like ETI and not used enough to be good at it?
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@ollieburtonmed
I don’t really get why the clinicians themselves want this title.
Are you not proud of your base profession?
Advanced Paramedic practitioner
Consultant nurse practitioner
Much clearer, still show you are a highly skilled clinician and let’s everyone know your training.
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@carlweb884
There’s always a way, my crewmate did an access course at 37 and started his paramedic course at 38 now he’s been in the road for 5 years
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Just to continue on from this incase anyone out there needs a quick refresher.
If you still use collars then they should be removed ASAP and replaced with some other form of immobilization as they raise ICP which in turn worsens secondary brain injury
If at all possible the
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Things like this can be so important, sometimes due to us seeing stuff like this every day we forget that lay people don’t know what all this kit is.
I can imagine this really helping a child’s frightened parents.
New mural painted by Dr Gillian Crowe, talented SpR in Anesthesiology!
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@HarryTtweets
What about standing infront of a family and saying yes I sent your mom to hospital for a 1:100,000 chance of X and now she can no longer walk due to muscle atrophy so her quality of life is now being stuck in her bed until she dies sorry I was just being risk averse.
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To anyone that writes advanced directives etc. What does “Unless treatable/reversible condition” actually mean I personally hate this.
Does a head injury on anticoags go in?
Sepsis?
I think it’s just too ambiguous and as crews do we ask the family? but that’s also not fair. Idk
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@loddyy24
It’s not as easy as that in real life though, if pt is major trauma I’m just opening the packaging and throwing it in the corner because my crewmate might be cannulating and I’m not gonna jump over his back every time I open a bandage or melanin or anything.
If I’m beside the
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I sometimes wonder if I was to come across this in person and called the PCI Cardiologist and explained my findings would they laugh down the phone at me or would they accept the referral?
Any paramedics ever go to PCI with a non STEMI presentation? How did it go?
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@h3l3na97
100% at a minimum 3rd year should be payed as your now making decisions and treatment plans etc
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I have nothing against ACPs and am happy to be treated by one but,
Why do they never accept GP referrals!!
I find if I’m handing over to a Dr the vast majority of the time they agree with us and accept, but I have only had maybe 30% of referrals accepted by ACPs.
Whyyy?
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@jerrytheamboman
@doctor_dru_
Nurses don’t make autonomous decisions to the same level that paramedics do. They don’t interpret ECGs. They don’t lead ALS. They don’t treat initial traumatic injuries or major traumas
Just as Paramedics don’t take or interpret blood results, don’t catheterise, don’t carry out
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Well what I’ve learned from the comments on this is that most ppl actually read our notes anyway so if we have good notes that’s where they get the info from
I’ve been getting frustrated recently with the info we give in handover vs what’s written down and passed to the doctor.
I will show an ECG with concerning peaked T waves and they type “crew concerned with ECG”
I might say rebound mc burneys point tenderness and they write “abdo
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@HattyFeldman
I actually think this could be the cause for eg. A nurse spends 10 years not holding final decision making decision or taking any risks then they do ACP and now suddenly they’re supposed to have clinical responsibility and risk management skills
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@HarryTtweets
I’ve never met someone that talks about statistics or non conveyance rates ppl just want to do what’s best for their pts.
Maybe do some shifts on an ambulance and see what it’s really like instead of just going off what you think the job is.
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@cmwilliams99
The amount of strokes and sepsis I’ve seen recently with pts / families saying “I’m so sorry we really didn’t want to call we know how much pressure you guys are under”
It’s so unbelievably sad when someone misses the thrombolisation window because of something like this
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This!!
Ofc with an over the phone triage you are going to get it wrong sometimes but I think it’s wrong more than it’s right and even the call handlers know it’s coded wrong but have to follow the algorithm.
I often read the few words we get passed through and immediately think
The triage system needs overhauling. I attended 3 cat1 calls last night and not one was deemed “life threatening”.
“Can’t breathe”, 1st party caller, speaking in full sentences..while the cat3 fall who’s been on the floor waits hours for an ambulance..
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Called the
#GP
and gave a brief synopsis and the ooh GP said that his notes seemed like no one had put all the pieces together until now. I feel for all you guys who have 10-20mins to get a history IDK how you do it.
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Yes yes yes!!
Ambulance staff hardly ever receive feedback on their patients, the only way to learn is to know what you do right and what you do wrong.
You can never get better if you didn’t even know you were wrong in the first place.
Feedback for paramedics is SO important. I recently performed my first ever chest decompression, when I took the patient to resus, i was told the initial X-ray didn’t show a pneumothorax, which spun me a little because I thought I had caused the patient some harm. (The doctors
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@NatashaMDay
Yeah it’s terrifying, happened to me a few months ago and I just said “okay well if you feel the need to act on them just let me know and I’ll get out of the ambulance” and they just said “sure”
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@HarryTtweets
@999Control
I think you need to learn what the paramedic curriculum is before you make comments like this, I would love to know what your job role is?
Paramedics physical exams are taken from the med student curriculums, we advise our students to use geeky medics app to pass their osces.
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This is a really important thread for all hospital based staff to understand that you only see the last 10-30% of our job.
It’s important for ambo staff to remember that the small everyday things we do actually are important and unique to our role. Even if it doesn’t feel it.
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As a Technician I’ve always wondered where the line is for following JRCALC for eg
I’ve seen and been shown how to realign leg fracture with vascular comp
In a hypothetical w/ no para but somehow adequate pain relief am I allowed to do it?
If not why?
Is it medicolegal stuff?
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@WelshGasDoc
Us ambulance people see this all the time in GP practices and clinics I always teach my students if you walk in and someone is on O2
- Check the tank valve is open
- Check the mask is right for the flow rate (it’s common to see 3L/min on NRB etc)
- Check SpO2 on room air
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@Dr_ErinLS
Not Med school but Paramedic school
- Brain tumor (I went and got a CT head😂)
- leukemia
- pericarditis
- PVCs (this one is true)
- health anxiety (this one is true)
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Also I wish I could edit that post and say they are experts in PHEM not experts in PH anesthesia.
Ofc paramedics are not experts in anesthesia it takes years of specialist training in anesthesia for that.
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This thread is amazing, I think is really important for people considering paramedics as a career and for qualified paramedics.
I think most Paras who aspire to be the best wonder if medicine is the next logical step for them, this thread might help answer that for you.
I end up speaking to paramedic friends and collages every few months about doing medicine. Is it worth it? What’s the process like?
“Should I do it?”
And my answer is essentially these three things I’ve discovered and learned from others
1/ 🧵
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Imagine we had this in the UK it would be amazing. Driving in the hard shoulder is scary and dangerous af.
German and Austrian traffic law requires drivers to form a Rettungsgasse (emergency vehicle lane) whenever traffic comes to a halt on the autobahn due to some emergency allowing ambulances, fire trucks, police, or any other emergency response
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It’s crazy how normal this stuff has become to us in the ambo service.
Often go to pts who called 999 hours ago who are now so unbelievably unwell when they defo could have been ok if we had just responded a few hours earlier.
So many people dying because of a broken system :(
Gets GP appt
Diagnosed with likely MI
999 called
.
.
No ambulances
Son ends up driving him to hospital
Arrests on route
Dies
This is EXACTLY what we are afraid is going to happen daily.
This is the Tory NHS
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@ThePtarmigan
For PH abx the indications I would be talking about is open fracture or severe red flag sepsis
And for furosemide would be acute pulmonary oedema
Some travel times in Ireland can be >1.5hrs to nearest ED so IMO these would be lifesaving interventions
All of these are
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@LukeAmos__
Yes that’s right but I’ll give you an example.
Terminally ill pt at home in bed wife is worried about pt so calls GP who organizes a phone appointment have a quick discussion but wife isn’t describing stuff properly so GP organized a home visit. Pt seems well just increases dose
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@TheRealRead
100% I love my job soo much but having my friends ask if I wanna go on a holiday with them and having to say sorry I just don’t have the money is pretty annoying.
Loving work is great but you also need a nice life outside
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@cmwilliams99
And if your GP practice doesn’t have access to an ECG and you need one urgently every single ambulance has one that should have been considered
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Random Q that has popped into my brain
If I was to help in a medical emergency on a plane
1.
Would it be illegal to identify myself as a paramedic since I’m not a paramedic in 🇬🇧 even though I am in 🇮🇪?
2.
Would I work to my higher 🇮🇪 Scope or my lower 🇬🇧 scope?
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@robpain635
I agree and I’m happy to do the ECG and percussion but don’t make me spent 10 mins doing them say there’s nil acute and then still say mmmmm sorry I’m not sure let’s just go to hospital just incase
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@doctor_dru_
I think it should say Doctor but should also say FY1 FY2 CT3 etc for other members of staff over general public. If I’m asking a doc to look at an ECG I’m worried about, asking an FY1 their opinion is very different to an ST. FY1 has probs seen less ECGs than my crewmate
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@ParaAndy90
Basically because it’s meant to be a good seal and a 1 way valve, so basically tidal volume is about 10L/min so if the mask fits proper and it’s set to less than 10L then the pt will be sucking a mask with no gas to breath in, I’ve seen it once they look like theyre choking kinda
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@ParaAndy90
Yesss 100% watching a GCS 5 go to being 15 10 mins later and then discharged at home another 20 later is immensely satisfying.
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@parapism
That was a single example of a common reason we would call
The entire point in Ambo service having access to OOH GP services is to treat suitable pts in the community so we are calling to get access to some treatment that we can’t give, if you don’t feel comfortable
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Just to clarify I do not think we shouldn’t have HEMS docs, they provide invaluable knowledge and expertise.
My opinion is more that you shouldn’t have to become a doc to be top of the field of PHEM.
Some trusts seem to be better at this sentiment than others.
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This one is difficult
On one hand if techs correct scope w/ airways and drawing meds etc then it’s a generally unnecessary skill
But on the other Ive been in many a situation where crewmate can’t get access and it could’ve been good if I could have tried just as fresh eyes
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@CruaFear
@marcus_mcdonagh
@thejournal_ie
There’s so many problems with Irish PHEM rn unfortunately, doing a 3-4 year degree and not being allowed to cannulate or provide basic life saving treatments, no furosemide for acute pulmonary oedema, no atropine for symptomatic Brady, no advanced pain relief, no IV fluids, no IV
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I was in normal clothes walking down the street like 10m away when he called after me, it just goes to show that “regular” jobs for us have a lasting impact on people and they can recognize your face out of a crowd.
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@parapism
Tbf the vast majority of GP practices have ECGs and if this is one of the practices that doesn’t every single ambulance has access to a 12lead ECG and the people to interpret them so calling us should have been at least a thought
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I think one of the best parts of ambulance work in the UK is the inter professional respect we get, if we call up any medical professionals and give our opinion 85% of the time they will trust our judgment and expertise. It’s one thing I would hate to lose if I ever moved home.
Tonight I had a conversation with a cardiologist about a patient I was concerned about even though it didn’t meet certain criteria.
The team trusted my judgment and 30 minutes later the patient was in and having a stent inserted.
Our NHS is incredible. We need to protect it.
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@TheLeeMcLaren
This is a crazy take IMO, people need enjoyment in their lives do you not watch TV or movies either?
Fiction books are just like movies to me a nice story that you can get lost in and forget your stress for a few hours.
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Salt and vinegar Pringles are NOT a substitute for sour cream and onion!!
Also why can’t I say no to this substitute?
I will just have to throw/give them away or something cuz I really dont want these ahhhh!
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@spippytea
I would argue most paramedics aren’t “academically minded”
Although the job requires quite a bit of theoretical knowledge it’s not the same as school where you learn stuff with no practical application
You remember stuff a lot more and are more interested in learning because
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What do ppl think about giving morphine to morphine seekers
I’m not talking just someone you suspect, I’m talking you open prev records and see they call 2x week and when they get to hospital they just get up and DC themselves
To give or not to give?
Give the morphine
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Withhold the morphine
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