Scary

So I had a very scary sick paediatric patient last night.  I wish I had more freedom to talk about my patients without worrying about medical-in-confidence issues.  Nevertheless, the medical issue was not really the point. 

There was a lengthy delay in getting to the patient due to many factors - all very frustrating and out of my control.  Then the patient didn't quite fit into our Guidelines, and was a pretty complex case and I required a consult, but where we were the comms was poor causing more delay. 

Then my patient started to deteriorate and I asked for the Intensive Care ambulance to RV with us, but they were unavailable.  So it was lights and sirens all the way into the regional hospital which was about 40-minutes+ drive.

At the hospital they didn't seem as prepared for us as I thought they should have been.  Maybe the notification didn't get communicated well.  Another problem with the Chinese-whispers system we have.  And they were expecting 3 traumas from an MVA and there are only 2 resus bays.  We finally got triaged and put in a monitored bay, which was fine, with a nurse to stay with the patient at all times.

I don't know what happened in the next 20 minutes as I was writing my case sheet, but the patient ended up going into resus with the parents extremely anxious and distressed about the level of care they were receiving.  I went in to watch/assist/comfort and from my perspective I thought it went ok, but that didn't help me sleep well last night and I still feel like crap this morning.

A summary of my "personal reflection" on the case, and what I'm beating myself up about this morning (then the actual rationalisation);

• Maybe I should have been more insistent from the outset to clarify more information about the location (I did ask for clarification multiple times)
• Maybe I should have asked for a consult instantly (but I needed that 5 minutes to properly assess the patient before I could know what I was asking for in the consult)
• Maybe I should have asked in my consult to do an invasive procedure that I wanted the intensive care paramedics to do (this most likely would not have been approved, nor would I have been comfortable doing it as I've never done it on a paediatric before, let alone one so small, and at that stage it was not immediately required)
• Maybe we should have gone to the children's hospital (but it was an extra hour's drive away and in my opinion the patient was too unstable)
• Maybe I should have keep my drawn-up meds and stayed in the bay with the nurse until a doctor saw them (this is totally unusual, and the patient was categorised very highly)
• Maybe I should know more about rare genetic diseases and their presentations and about more things that are not covered in our guidelines (there is only so much a paramedic is expected to know and I am learning more everyday, but I can't know everything instantly.  And anyway, paramedics are really only required to treat the symptoms as they present)

Ok, I feel a bit better now I've put that out into the world.  Maybe I can re-read this post if I even have to given a testimony in court!  I hope it doesn't get to that. 

It was after 1am when I got home and I still had to read up about the medical condition, and itcs complex presentation, in my text and online with my eyes falling.  And guess what, I'm probably going to spend all of today doing that same thing.