Care factor intensive | PHOTOS

3.30pm: Elderly Newstead woman with heart palpitations and chest pain..

When paramedic Andy Warnes tells us we have just missed something amazing, I laugh, thinking he's joking.

We've arrived at a well-kept Newstead home minutes after Andy and intensive care paramedic Angela Hodgson, entering without knocking.

They're both crouched before the patient, Nancy*, as she sits attached to a heart monitor, with a drip in her arm.

All three are calm as they pause to introduce themselves, so I'm surprised when Andy tells me they have just reset Nancy's heart.

Nancy was suffering a rapid heart rhythm and chest pain, and Angela administered the drug Adenosine to revert her heart rate back to normal.

"It's an intravenous drip and it basically stops her heart, which is why we have defibrillator pads here ready, just in case," Andy explains.

For a few long moments, Nancy would have felt like she was dying.

Now she's more concerned about finding her dressing gown, slippers, and making arrangements for her car. She was meant to collect it today.

"I was going a whole 12 months without one of these," Nancy says, referring to the ambulance call-out. "I didn't think this would happen today."

Andy and Angela follow Nancy's directions to find what she needs, soothing her concerns about the wet washing in the basket and what her neighbours will think.

"Things seem nice and calm and that's what we want," Andy says quietly.

"Things could go pear-shaped really quickly, so we're watching her heart rate all the time.

"She's at a heart rhythm which can't be sustained."

I watch the monitor nervously, unable to interpret its movements as the paramedics help Nancy find her things.

"It just seems silly when I feel all right," Nancy says as they load her into the ambulance. "But they look after me wonderfully when I have these episodes."

The care factor . . . intensive care paramedic Angela Hodgson and paramedic Andy Warnes, at work with an elderly patient at Newstead. Picture: Scott Gelston

The care factor . . . intensive care paramedic Angela Hodgson and paramedic Andy Warnes, at work with an elderly patient at Newstead. Picture: Scott Gelston

4.20pm: Launceston General Hospital with Rebecca Dudman.

Sometimes Rebecca Dudman sees faces and flashes from the call-outs she'd rather forget.

"I still see images, from SIDS (sudden infant death syndrome) babies to more extreme things, but I don't want to say what they were because they really are extreme," the Campbell Town branch paramedic says.

"People don't understand what we end up seeing."

Contrary to popular belief, however, Rebecca doesn't spend most of her time responding to car accidents and traumatic events.

She says she rarely has trouble separating her work and home life.

We meet her at Launceston General Hospital, where Andy and Angela have safely delivered Nancy to emergency department staff.

Rebecca has just delivered two patients of her own, having transferred them from St Marys Community Health Centre.

Transfers are a common job, with another ambulance arriving as we speak with a patient from North West Regional Hospital.

"A lot of the time they are transferred out because they've become unstable, they're sicker than what St Helens hospital can handle, or they need services that are only available here," Rebecca says.

There's no "typical" job for paramedics. They receive call- outs related to mental health and self-harm, chronic disease management, chest pain, acute injuries and car accidents.

"These days the work is really quite diverse," Rebecca says.

"You have to be a friend and a social worker."

5.20pm: Ambulance Tasmania Mowbray station.

Day shift is almost over for Mandi Hutchinson and Natalie Koning, but they are off the couch and out the door when we arrive at the Mowbray station.

Their pagers have just sounded. A woman nearby is suffering abdominal pain.

In a case of emergency paramedics only need to observe one road rule - school zones - so Mandi and Natalie are well under way when we arrive at a busy family home.

Natalie is trying to talk with a woman who appears to be living with disability. Cindy* is confused about where she's feeling pain and talks little, but is clearly distressed.

Several children watch on from the kitchen and another woman sits on a nearby couch, a game of Candy Crush sitting interrupted on the iPad on her lap. A girl about 12 years old darts into the room, eagerly offering us a cup of coffee.

Natalie tries to have Cindy rate her pain between one and 10, and eventually gets a five. She talks loudly but gently, peppering her speech with lots of "darlings".

Cindy's blood pressure and heart rate are normal, but she's dizzy, and Natalie and Mandi aren't taking any chances.

The Candy Crush fan follows the paramedics as they help Cindy to the ambulance, then reassures Cindy that she will see her later.

6pm: Ambulance Tasmania Launceston branch with Joel Thompson.

Joel Thompson and Rhanna Grigor have just started a 14-hour night shift.

They're at the Launceston station watching television, waiting for their pagers to sound.

What will tonight have in store?

Last night it was a transfer to the airport for air transport; a young woman who attempted suicide, a man with a chest infection and a woman with diarrhoea and vomiting.

Joel, a former nurse, says the variety, autonomy and thrill of not knowing what's next is what he loves about the job.

But the perks can spawn the greatest challenges.

"You can find yourself stuck in awful situations, away from any assistance," Joel says.

"I was the ICP (intensive care paramedic) at Scamander for a couple of years, and if you got a nasty job at Bicheno, it was two hours to Launceston or Hobart with a volunteer."

It doesn't appear tonight will be one of those nights. One-and- a-half hours in, and Joel and Rhanna haven't been called to a job.

Like every paramedic we've spoken to, Joel is buzzing about the first case we witnessed, with Nancy.

"That's the work we're meant to do," he says.

Joel says he gets frustrated by people who misuse ambulance services.

"We went to one fella last night who couldn't figure out how to get to the LGH from Deloraine, so we had to drive out there and show him," he says.

"We get cases of conjunctivitis, mouth ulcers, constipation and sometimes it's as basic as them not having enough petrol to get to the hospital."

Almost two hours in, and his pager sounds. An 18-year-old girl at Trevallyn is suffering chest pain. She has recently had a chest infection.

And they're off.

Paramedic Andy Warnes and intensive care paramedic Angela Hodgson load a patient as Northern region duty manager Lynden Ferguson supervises. Picture: Scott Gelston

Paramedic Andy Warnes and intensive care paramedic Angela Hodgson load a patient as Northern region duty manager Lynden Ferguson supervises. Picture: Scott Gelston

7.30pm: Trevallyn with Lynden Ferguson.

The days when paramedics would chuck someone in the ambulance and transport them to hospital are over.

There's no better example than tonight.

We're in the car while Joel and Rhanna give some advice to the 18-year-old with chest pain.

She's OK, and won't need to go to hospital, but isn't too keen for the added company of a newspaper journalist and photographer.

In the car, Lynden enthusiastically explains how the ambulance service has changed.

He tells us that 15 years ago, Nancy's story could have been very different.

Paramedics would not have been able to administer Adenosine to revert her heart back to its normal rate.

"That, along with some other treatments we do now, used to only be done in the emergency department," Lynden says.

"We're not just ambulance drivers anymore. We can really make a difference."

Andy and Angela were also able to perform a 12-lead electrocardiogram to measure the electrical activity of Nancy's heart.

The procedure helps paramedics identify heart attacks early in certain patients, where previously they could only have gone off symptoms and patient history.

"In Victoria, your average paramedic does not do a 12-lead ECG, but all ours do and that's actually a big deal," he says.

"If you're having a heart attack now, when we come into DEM they're going off our diagnosis and the surgeons are already prepped and ready if need be.

"So by notifying the hospital from the home we're giving the patient the best possible outcome, saving the heart muscle and giving them the best possible quality of life."

All sorts . . . dealing with a drunk patient at South Launceston. Picture: Scott Gelston

All sorts . . . dealing with a drunk patient at South Launceston. Picture: Scott Gelston

9pm: Sick person, in a state of altered consciousness. Launceston.

We climb a long flight of stairs to a small unit, and the first thing I notice is the smell.

Joel is crouched before a 50-something man, who gazes dopily at us from the couch. Rhanna hangs back.

There are wine casks on the floor and dozens of unrolled cigarettes scattered across his coffee table.

"This is Max*," Joel says. "He's had nothing to eat for three days and there's three empty casks of wine here, so he's not feeling too good. How much have you had to drink, Max?"

"F---in' heaps," Max says.

Max blurts and slurs like his tongue is a lump of lead. He tries to answer Joel's questions on when he last took his medication and why he stopped, but he doesn't know. Maybe he ran out.

"You're all wet, have you peed yourself?" Joel asks.


Max doesn't want to go to hospital. He was there just two weeks ago for chest pain, and is convinced hospital staff will be "p---ed off" at him.

Joel reassures Max that they will just want to help, and asks if he's feeling any chest pain now.

"There's nothing there," Max says.

"There's nothing there, meaning you don't feel any pain?"

"No. I just feel like everyday drunk."

Joel tells Max they need to figure out a management plan: if he refuses to go to hospital, he will have to rest and drink plenty of fluids.

Max says he'll just drink a lot of beer.

"Your heart rate is really quite fast - double what it should be at rest," Joel says.

"I try to stop, but I can't," Max responds.

In the end, it doesn't take much to get Max to hospital - though getting him down two sets of stairs is no simple feat. It would be funny if it wasn't so tragic.

As paramedics help Max collect his things I notice several photos of a child, about 10 years old, on the walls.

At the hospital, Max records a blood alcohol reading of 0.4.


There were other call- outs in the nine hours we spent with Northern paramedics.

There was a man with chest pains, a woman with disability whose carers suspected her health was deteriorating, a man with breathing difficulties, a woman suffering a severe allergic reaction, and a young man with schizophrenia who called triple-0 from a phone box hours after he'd been made homeless. He had nowhere to go.

Many of them were alone.

The paramedic pager, which alerted us of every job, painted a picture of a different Launceston that co-existed with mine, where people were sick, in pain, homeless or scared. For many, there's only one number they can think to call.

Who else could have helped Max, the drunk man soaked in his own urine? And what other strangers would people accept so easily into their homes?

Lynden stressed the growing medical expertise of paramedics, which was certainly clear. But I was struck most by how they acted as social workers, providing the right amount of reassurance and comfort in every situation.

In Tasmania, ambulance demand has risen with emergency department demand, increasing more than 12 per cent in the year to July 2013. Lynden said the role of Ambulance Tasmania would keep evolving to manage this demand.

He predicted that paramedics would be increasingly focused on referring patients to the right service, rather than just taking them to hospital.

"It's quite an exciting field, the scope's expanding and we really are an important part of the health service," Lynden said.

"The community relies on us."

* Names have been changed.*

* Northern region duty manager Lynden Ferguson is Health Minister Michael Ferguson's brother. This story was arranged independently of that relationship.


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