Summer in the work of a paramedic
Do paramedics have to intervene more often than usual during the holidays and what type of interventions are they?
There are indeed more interventions. In the Emergency Department of the Children's Clinical Hospital UCK WUM, where I work, patients with injuries predominate during the holidays. This is a time when children and young people spend more time outside and undertake many different activities. In the case of toddlers, many injuries are associated with their mobility and curiosity to explore the world. These are most often head injuries: this part of the body is the largest and most weighted towards the ground when falling. Slightly older children often suffer from a fall on a bicycle or a fall from ladders or other equipment on the playground. Characteristically, after the age of 12, girls are less likely to be injured than boys who engage in riskier types of behavior. The older the adolescents, the more often psychoactive substances can contribute to the injury. It is also worth remembering that the holiday period is a time of increased work in agriculture. So in the summer, some of our patients are victims of agricultural accidents. Fortunately, there are fewer and fewer of them – but they happen.
What activities of children and adolescents are conducive to injuries?
Increasingly, we are dealing with injuries on a skateboard or cross bike. Mostly boys perform various stunts on them without wearing proper protectors or helmets, and this leads to head and cranial or facial injuries. Many injuries occur on electric scooters and scooters. Teenagers ride them without helmets, and it happens that after drinking alcohol or taking drugs.
From the perspective of our Emergency Department and the Children's Trauma Center, it is clear that children and adolescents are taking up new and riskier activities. We have patients with injuries that hardly happened before, such as intentional or unintentional gunshots from pellet guns or even firearms. I remember the case of a boy whose injury was caused by an arrow from a bow stuck in his leg. We also happened to help a girl after she had parachute accident. It should also be noted that among the people who go to the emergency room there are victims of various "challenges" on social media. These are various challenges, from practically harmless ones like eating as much breadcrumbs as possible on time to very dangerous ones like taking a selfie in a strange place, e.g. at high altitude. This last challenge can easily end in a serious accident leading to death or disability.
During the holidays we often hear about accidents on the water, do they also happen on holidays in the city?
Yes, we sometimes help children who have suffered accidents in the water. In Warsaw itself, as well as its surroundings, there are many places where you can spend your free time by the water, such as the Zegrze Lagoon, large water parks or municipal swimming pools. In addition to flooding, there are also accidents that occur during diving. Among our patients was a young diver who came to us with barotrauma, or pressure trauma. Diving is an extreme sport in which accidents are rare but when they do occur, they are often tragic.
The Emergency Department often receives patients who could also receive help from the primary care unit. Many ambulances come to the aid of the sick, whose lives are not at all threatened. Why?
We have quite a long list of medical rescue activities listed in the Regulation of the Minister of Health on medical rescue operations and health services other than medical rescue activities, which may be provided by a paramedic, which a paramedic can perform independently. This act also contains a fairly long list of pharmacological agents that a paramedic can also administer himself. In the case of Emergency Department, the doctor decides what these activities should be, and sometimes the coordinator of the department. However, in medical rescue teams, the decision is made by the team leader or the paramedic himself. And these can be very different interventions, both those within the canon of first aid, as well as medical rescue operations, among which we can mention immobilization of limbs and spine, the establishment of intravenous accesses, the supply of medicines, supplying the respiratory tract in a definitive way as well as taking actions aimed at maintaining basic life functions and their improvement. It is worth mentioning that, within the State Medical Rescue system, there is also an Air Rescue Service, where, in addition to typical rescue tasks, medical rescuers act as a pilot's assistant during air operations.
To start acting, you need to know what is happening, should the paramedic also carry out the initial diagnostics?
Of course, 70% of working with a patient is collecting a good interview. Added to this is the appropriate examination. And then we start to act according to detailed guidelines developed by recognized international and Polish scientific societies developing specific recommendations. However, it is worth remembering that knowledge of the guidelines is not everything. In the work of a paramedic, two more elements are mentioned, which the English-language literature defines as: street smart and a gut feeling.
The term street smart does not only occur in relation to the work of paramedics. This term can be defined as the experience and knowledge necessary to deal with potential difficulties or threats. These are elements that, with continuous practice, paramedics will develop and thus predict what injuries and injuries may occur in the victim or victims, on the basis of information received from the dispatcher and the general impression at the scene of the incident.
A gut feeling is a hunch that sometimes differs from the usual practice or solutions proposed by the guidelines already mentioned. Nevertheless, it often brings benefits to the patient or the injured person.
It is said that a paramedic often has to take on the role of a psychotherapist, is this true?
Indeed it is. Communication skills included in the so-called soft skills are particularly important. If the patient is a child, we must prepare him or her for what is about to happen to him or her, for medical procedures that may be incomprehensible to him or her, for a new environment, for the pain that may arise, and so on. This kind of conversation needs to be arranged a different way for a small child, and also for a teenager. An additional challenge here will be a frightened, frustrated, sometimes even aggressive parent who has a distorted image of the whole situation.
Even more difficult are interventions involving suicide attempts. Here, the role of a paramedic, in addition to performing rescue activities, is also appropriately adapted psychological help. A paramedic sometimes has to play the role of a therapist, not to judge, but to support and at the same time collect as much information as possible about the circumstances of the incident, which may be crucial for the further therapeutic process.
Communication problems also arise when dealing with a geriatric patient. They are often lonely people who do not require urgent life-saving interventions undertaken as part of emergency medical teams. It happens that elderly people call an ambulance because they feel worse, they need care, someone who will listen to their problems.
The emergency room often receives patients who could receive help in the primary care unit. Many ambulances go to the sick, whose lives are not at all threatened. Why?
It happens that patients who should report to the Primary Health Care or Night and Christmas Medical Assistance come to the Emergency Department for help. In many cases, it is a matter of not knowing where and when to turn for help. It happens that people who come to the emergency room themselves or call an ambulance do not know that they have their own POZ doctor they can go to. Even more patients have no idea that there is Night and Christmas Medical Help, where they can also get aid. There is a belief in our society that if anything happens, you have to call 999 or 112, and the hospital is the best place to get help. The patient's ability to reach the right specialist is a matter of knowledge that paramedics, as representatives of medical professions, should promote.
The work of a paramedic is very stressful. How to deal with it?
In my opinion, the most important thing is to follow the principle of work-life-balance. It's not easy. There are still not enough paramedics. Therefore, many of them decide to work in several places. Meanwhile, at some point you have to be able to say stop. Especially when, in this work, we encounter very difficult, sometimes traumatic situations every day. These affect our psyche. Some use the mechanism of denial - they leave work and do not think about what happened there, they try to forget it. Others process and really feel every intervention. Both attitudes can cause the psychological burden to accumulate and, as a result, it can lead to burnout.
Fortunately, in many medical facilities there is a psychologist who, for example, conducts debriefings with teams that participated in the most traumatic events. Every employee can and should report to him or her if he or she feels that he is not coping with something or the professional situation is beyond him or her.
What is the most satisfying thing about your job?
In the medical professions, we can never say that we have already learned everything. Every day brings something new. For example, we have a situation that seems simple on the surface, and then turns out to be completely unusual. Then we have to look for a new way, new solutions. And this is what gives me the greatest satisfaction.
Interviewer: Iwona Kołakowska
Photo by Michał Teperek
University Communication and Promotion Office