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00:04Oh, cardiac arrest coming in. Dolly mount!
00:07It's one of the most pressurised jobs in the world.
00:15Becoming a paramedic is not for the faint-hearted.
00:18So, it's going to be a little bit of pulling and dragging.
00:20That's okay.
00:23No, it's okay.
00:25Each year, the National Ambulance Service College
00:28welcomes around 90 new hopefuls to their campuses
00:31in Dublin, Ballinasloe, Tullamore and Cork.
00:34These people here are going to be your absolute backbone
00:37over the next three years.
00:40But not everyone makes it true.
00:42I don't think I'm going to do this anymore.
00:44It's just shit, like, I'll go the last two days.
00:48Because this is no ordinary degree course.
00:51Where are you going to go? It's cardiac.
00:56These students are out in ambulances across the country.
01:00999 mode activated.
01:04Learning on real emergency calls.
01:07Here, here, here, here. It's over there.
01:11With every shift a crash course in courage.
01:14It doesn't get any harder than this.
01:16Resilience.
01:17Lift.
01:18And critical decision-making.
01:20We have a device that brings the bones back into place.
01:22But it's going to cause them to scream.
01:24Big, deep breath for me.
01:25The exams on this course aren't just a pass or fail.
01:29Ugh, why did I sign up for this?
01:32They're a potential matter of life.
01:34Are you going to wake up for me?
01:35Or death.
01:36We're not breathing.
01:51Time for Labor.
01:53The patients inside the house items come across that are confusing.
01:56But the car is outside the house and can't get into the patient, Robert.
01:59Ah, that so looks lovely. Thanks.
02:01In Castle Bar, second year student Ryan is on shift with advanced paramedic Tommy.
02:07Now Tommy, you need to let me think of my own questions to ask the patient and just give me
02:12a chance because you have the question like this, bing, bing, bing, bing, straight away and I just need a
02:17minute to think of the question.
02:18I will get to where I need to be, but it will just take me a wee bit longer than
02:23you said.
02:23I will be nice and quiet.
02:27Today, the lads are responding to a call from an elderly lady's relative who is concerned for her welfare.
02:33We were tasked to an address for a lady who was generally unwell.
02:36It was coming in that she had a build-up of fluid in her lower limbs.
02:40Eight, nine, and her mobility had been reduced the last number of weeks.
03:01When we arrived at the address, we were met by the patient's next to Cain.
03:06We advised that the patient has stopped responding to her.
03:10The next to Cain advised that the patient was within hearing distance.
03:15TV's on, anyways.
03:17We had to look then at other means of access to the property, given that there was a concern
03:22for life and having the patient's best interests at heart as well.
03:27I'd have to climb in over the wall.
03:30I'll try it. Come on, Ryan.
03:34We went round to the back of the property, big high wall.
03:37I'm not quite as athletic as Ryan.
03:40I'm younger than you. Do you want me to try it?
03:43Just go down there on your hands and knees and then just down on your back.
03:46Oh, yeah. This is marvelous now.
03:47Jesus, will you mind yourself? Will you mind your back, will you?
03:50Here.
03:51Tommy attempted it, but it was unsuccessful.
03:54And so I gave it a gander then and, and, yeah.
04:03Jumped it and with a bit of assistance, of course.
04:06For God's sake.
04:07He's in.
04:08It's probably locked.
04:09Probably.
04:10Ah, Christ.
04:17Is it locked?
04:18Yeah.
04:19Right, come on.
04:20Again, the back door was locked, so we contacted the guardee to see if they could come.
04:25Did she say how far the guards were?
04:27There's no ETA for them.
04:28Well, the two things, concern for welfare and acting in the best interest of the patient.
04:34That's the two things for getting an access.
04:39The guards couldn't advise of an ETA and there was a concern for life from our end because the patient
04:45was now not responding to our requests.
04:48I want the ambulance service.
04:51So can you come out and open the door or we're going to have to push it in?
04:56Again, tried multiple times banging on the door, shouting through the letterbox.
05:01Nothing.
05:02Couldn't hear anything.
05:03There's people out here concerned about you.
05:05You have to answer me.
05:07We need to kind of be looking to see, is there something seriously wrong here?
05:10Why is this lady not answering us?
05:13Hello?
05:14How are you?
05:15So look, I can probably push the door in.
05:18I made the decision that we were going to put the door in, but again, I asked for permission first,
05:23if you think it's okay.
05:25And we got permission to put the door in.
05:40Like Ryan, 31 year old Nathan is also a second year student, officially titled as an intern paramedic.
05:47How do you think your internship is going?
05:50Six months in and it seems to be going well so far.
05:54Like there's been a good mix of the normal everyday calls and then the, the oh dear calls.
06:03I'm out of my 52 week placement now as a paramedic intern.
06:06And that's kind of when the really hard work starts and the proper learning starts because you're learning.
06:11I'm learning from the crews I'm on with.
06:14Training for a sport, it's not until you're in the county final that, you know, there's training and there's match
06:21fitness.
06:21Yeah.
06:22And like what they're doing in the college is like training.
06:26But when you're on the road, that's where you need to match fist bearings.
06:29And then also we have our kind of on the road assessments to throw in.
06:34And it's been tough because I'm now rostered instead of just going to a college where I'm Monday to Friday,
06:39kind of nine to five.
06:40It's days and nights and kind of lots of different shifts.
06:44And I have a family at home as well.
06:45And it's been an awful lot tougher to kind of juggle all of that.
06:53Today, Nathan and advanced paramedic Declan are responding to an emergency call in New Ross, where a woman has fallen
07:01outside her home.
07:02So this is 40 year old Jenny, just a simple follow over the door, just a injury to the left
07:08ankle.
07:09On arrival to the call, we found out that there was actually an off duty advanced paramedic who lives fairly
07:15close by and his friends with this patient was on scene.
07:17So Paul was already there and because Paul is an advanced paramedic supervisor, he was able to run up to
07:23the New Ross ambulance station, pick up a drugs bag and come back down and kind of start kind of
07:28the initial treatment.
07:29There is a bit of a wound there compared to where it hit the ground.
07:32Didn't do anything with it as you've just splinted.
07:34And Pentrox.
07:35Pain score up around 8 when I arrived.
07:38Pain score is 0 or 10 now.
07:39We have quite a lot that we can do as paramedics when it comes to pain relief now.
07:44We have Entinox, we have Pentrox, we have Paracetamol, Lipoprofen.
07:48And to have that kind of started there already when we got there is a kind of big kind of
07:53weight off our shoulders.
07:54How long has she had the Pentrox for?
07:56Just literally, what time is it now?
07:58At 1543 Pentrox started.
08:01How's that pain at the minute?
08:03I have no pain.
08:04Okay, do me a favour, take your finger off the top of this for a few minutes and you can
08:07keep taking it without the finger on the top.
08:09Alright, good woman.
08:10I wasn't that meant to be.
08:11No, no, it's just you get a little bit of a stronger burst when you put the finger on top
08:15and I think you might have had strong enough a burst.
08:18The Pentrox had started to kick in.
08:20Pentrox can be quite an interesting medication to give people because it can make you quite funny sometimes.
08:26It can make you seem like you're drunk and it was certainly having that effect with Jenny.
08:31She was definitely getting the full advantage of the Pentrox.
08:34It was definitely doing its job.
08:36No, no, yeah.
08:37It's not me guarding you, you're probably stinking.
08:40Give me a favour.
08:41Oh, yes, you're like.
08:42Bend up that knee.
08:42What do you need?
08:43You don't need the other one.
08:44Bend up your leg.
08:46Give me this.
08:47Oh, yeah.
08:48Here.
08:48Can I have some of these when I go home?
08:51No, just like five or ten.
08:53Just a spare, come the spare ones.
08:55Just five or ten.
08:56Thank you so much, dad.
08:58Well, alright.
08:59And lads, do you know what the worst thing about it all is?
09:02What?
09:02That I'm going to the Coors tomorrow.
09:05The Coors?
09:06A couple of bottles of Coors.
09:10That's as close as you're going to get down now.
09:16All Jenny was worried about was going to a Coors concert.
09:20We kind of realised between ourselves that she probably wouldn't be going.
09:26Probably best not to.
09:27No.
09:27I don't mind things like that.
09:29Can I just have a look now?
09:32Can you get it?
09:33Take some deep breaths of that.
09:34No, I can't.
09:35Oh, that is it.
09:37I have the pulse marked on it there, Dicky, if you want to.
09:40Just recheck it.
09:41It's a bit off there.
09:42The toes are cold.
09:43Three, four.
09:45Here's where this kind of Coors becomes dangerous.
09:47Jenny's ankle had been completely dislocated from the joint that it's meant to be in.
09:52And it might even require resetting it.
09:54Dicky, it was about a tree when I...
09:56Yeah, I suppose a fight now is at least a fight now.
09:59Yeah.
09:59And I can't feel no upholster.
10:12In Castle Bar, second year student Ryan and advanced paramedic Tommy have gained entry into the home of an elderly
10:19lady over concerns for her welfare.
10:25We went in expecting to see a patient unresponsive on the ground, but the lady was sitting in the corner
10:32listening to a radio station, so there was music playing.
10:38How are you?
10:39Why did you break my door?
10:41I asked you to answer me, and I thought you'd fail or something had happened to you.
10:44Where?
10:45You have to see how we're concerned about you.
10:47No.
10:55No.
11:12No.
11:13No.
11:13No.
11:14No.
11:14No.
11:16No.
11:18No.
11:20No.
11:22No.
11:27No.
11:27No.
11:27So Ryan, as he always is, is the good cop, and then I just have to be the bad cop.
11:34The way it is, I don't think you've made an appointment to the doctor.
11:37And with all that swelling of the legs, that's all backing up, it's all putting pressure
11:41on your heart, and that's where all that fluid goes.
11:44And there is a risk with all that fluid that your heart gets under too much pressure and
11:47you could die.
11:48Come into the hospital, get your medication, get the legs back under control, and then
11:53you'll be able to move around here more comfortably.
11:56I am not good.
11:58There was no way she was going to hospital, and she really needed to, and I explained
12:02the reasons for her, and I explained why she possibly needs to go.
12:05Tommy has already outlined risks of not coming with us.
12:08Do you understand those risks?
12:10I have nothing to say to you.
12:11But you need to repeat back to us that you understand that you could die.
12:14You need to say that back to us.
12:16What's the risk?
12:19Die and die.
12:23It's hard to walk away because then you're thinking, oh, what if something happens in
12:26the next while?
12:27And then it's always there, oh, the ambulance was out a while ago, why didn't they take her
12:30in?
12:30And then eventually it comes to a point where a decision has to be made.
12:33It's either yes or no.
12:34Are you going to let us or not let us?
12:36At the end of the day, we cannot kidnap people.
12:38We have to respect a patient's autonomy and their decision to be wrong, their right to
12:43be wrong.
12:48In Wexford, second year student Nathan is treating Jenny, who had been looking forward
12:54to a Coors gig before she fell and suffered a bad fracture of her lower limb.
12:58Once we took it off, we realised that it was a little bit more than just a simple kind of
13:02fracture.
13:03It was actually a fracture dislocation and it was starting to cut off some blood supply.
13:09Because the blood supply is a teeny tiny little bit slow, we want to try and get that blood
13:14supply back again by putting it back where it's meant to be.
13:16All right.
13:17The foot.
13:18The foot.
13:19They're going to call a doctor in Cork.
13:21Basically explain what's going on.
13:22Well, the Coors are in Cork tomorrow.
13:24So I could go there.
13:26Without urgent intervention on scene, Jenny is in danger of losing her foot.
13:32So it's going to be a little bit of pulling and dragging.
13:34That's okay.
13:34All right.
13:35It might feel very strange, but you won't remember it as Becky said.
13:38That's okay.
13:38I don't mind that.
13:39I'd like to class myself as kind of knowing what was going to happen with dealing with
13:43a fracture and dealing with certain things.
13:46But this is now out of my kind of bag of tools.
13:50This is getting into higher kind of clinical territory and I knew that my job now was to
13:55just try and explain what was going on to the patient and also kind of explain what was
14:01going on to myself a little bit.
14:03Now it's cocktail hour.
14:05Lovely.
14:06This one to give horses?
14:08Not this stuff.
14:09No.
14:10I'm just going to give you another little bit of pain relief first.
14:12Lovely.
14:14And then I'm going to give you the stuff to give to the donkeys.
14:17Oh, lovely.
14:18I'm a real ass, anyway.
14:20Members of the public know ketamine as the horse tranquilizer.
14:24In an ambulance, it's used and much lower dosages, obviously.
14:28It's still effectively the same drug, but it's not used for the same reasons as a vet
14:33would use it.
14:34All right then?
14:35I'm all right.
14:36Good girl.
14:37Yeah.
14:38You might feel a little bit weird now, but...
14:40It doesn't matter.
14:41It won't be unusual for you, don't I think?
14:43It's just no pain.
14:43What?
14:44Are you saying that weird?
14:46Hey, I can still understand things.
14:49You all right?
14:50Yeah, I'm starting to feel weird now.
14:52Yeah, good girl.
14:53Off I go.
14:54Bye, Dan.
14:55I'm going off now.
14:57Oh, lovely.
15:00All right then, Jenny.
15:01All right.
15:02Just let her turn around.
15:03That's it.
15:07Squeeze my hand there.
15:08That's it.
15:09Well done.
15:10Just pull that down this way.
15:13Once you relocate something like that, there's going to be possibilities of a fracture there,
15:18and she will probably end up going for surgery.
15:21Can you wiggle those toes?
15:22No, no, no.
15:24Does that feel any better since before we popped it back into place?
15:28You didn't talk back into place.
15:29We did, yeah.
15:30When?
15:30We knocked out for a few minutes and popped it back into place.
15:33Oh, you?
15:34Oh, that's bloody brilliant.
15:35Are you messing?
15:36No.
15:37Here's me thinking I was the right one.
15:38Now you knock me out.
15:41Did you, Mommy?
15:42Mommy, seriously?
15:43Seriously?
15:44You're all sorted.
16:07In Dublin, second year student Aoife and experienced paramedic Rory have been called to a suspected
16:14cardiac arrest at a housing complex.
16:21I'm going to stay down here.
16:24So, obviously, when we arrived on scene, we were trying as quickly to get all the equipment
16:27out and get to scene, but we were met by a member of DFB who informed us that he was
16:33dead in the arrival.
16:36Despite being at the scene within minutes of the call coming in, it's clear the man had
16:41been already dead for several hours.
16:44Who called in?
16:45The room was across the room in 29.
16:47Oh, God, look.
16:49We entered the property.
16:50It was quite unkept.
16:52It was very dirty.
16:53Evidence of drug use all over the house.
16:56Sharps everywhere.
16:57And before we enter the scene, we look for our scene safety.
17:01So, scene safety is something down as far as putting your gloves on, goggles, gown,
17:04that kind of stuff.
17:05As well as before you actually step into the room, you have a look around the room, see
17:09is there anything that could be a hazard to you or your colleagues or anybody else that
17:13might be coming in the door behind you.
17:15In that particular scene, there was sharps everywhere.
17:19We'll do a quick trace just to make sure everything is what it is.
17:22So, you put on the monitors to check if he has a pulse or he has a heartbeat, check his
17:27pupils, see if his pupils are reactive, if they're fixed, if he has any breath sounds.
17:33Yeah, pupils are fixed.
17:35Yeah, fixed, colds, pooling, everything.
17:37Yeah.
17:38It's quite upsetting, obviously, to see the poor standard of living that the patient had
17:42had, and I suppose heartbreaking to think that we've lost another life to a possible drug overdose.
17:50People don't decide one day that they just want to do drugs.
17:54They fall in with the wrong people, maybe, and it's an addiction.
17:56It just gets worse from there.
17:58They might have an awful lot going on that we don't know around in the background,
18:00so mental health could be a bit of an issue there.
18:02And the problem with drugs is it's an addiction, and it's a worsening addiction.
18:08So, the more you do, the more you need.
18:10The risk is that you might find yourself alone, and nobody's there to help you.
18:15And if you use too much of the medications, the drugs, the end result is the end of the line.
18:21It's death.
18:22No matter how often you do those calls, they're always going to be upsetting.
18:26That's somebody's child, that's potentially somebody's partner or father even, you know.
18:33And he's young enough, I'd say approximately 40-year-old male.
18:37So, yeah, look, it is upsetting.
18:39And not just for me, obviously, for an extended family somewhere,
18:42they're getting some bad news now shortly, you know.
18:49For paramedics all over the country, dealing with death is a difficult but inevitable part of the job.
18:57It can be tough for us.
18:58I'm doing this a long enough time now at this stage, I've seen a fair share of them.
19:02It doesn't really get any easier.
19:05It can be emotional, it can be hard, especially for anyone who's brand new into the job,
19:09and they've never seen it before.
19:14Sometimes there's calls we arrive to, and there is nothing that we can do.
19:18And sometimes you have to just take a step back and maybe go,
19:20be the person to go do the paperwork in the back of the ambulance and take a minute.
19:25I had one big call where I had huge questions after it,
19:30whether I was the right person for the call.
19:33It was a paediatric arrest and it had a sad outcome.
19:40It's that fear and that self-doubt you have that you're not quite good enough.
19:48Dealing with the call amongst your colleagues, talking with us amongst your colleagues,
19:51is the most important thing.
19:53Don't ever bring those calls home.
19:54Don't try to deal with them yourself either,
19:56because we're not meant to process things like that really, are we?
20:00At the end of the day, nobody's meant to see those kind of things.
20:02You know, we need to mind ourselves and each other.
20:09We've had a lot of drug-related calls lately, haven't we?
20:12Yeah, the whole of yesterday was all drugs, alcohol-related, you know.
20:17It seems to be a growing trend and it seems to be getting worse at the moment,
20:22but just too late for that gentleman there and you don't wish that on anyone,
20:27you know, so just too little too late for him, I suppose.
20:30Very sad outcome.
20:32Yeah.
20:41I don't think we'll be wrong.
20:48It's a real disaster.
20:48It's a real disaster.
20:49I think it's not a real disaster.
20:49I, you know…
20:49It won't seem to be wrong.
20:50We're trying to understand what, you know…
20:53For the last time, you know, it's a real disaster.
20:53It's a real disaster.
20:54To make her bad things, we'll be going to go to the end of the day.
20:56To make her bad things, we want to get into action.
21:01I think I'm really eager to be away.
21:01I don't have to leave.
21:02We're just getting more details here now.
21:06Four car RTC, two to three cars and one van.
21:10It came in from fire control, so somebody obviously rang the fire service.
21:14So there's an ambulance almost there from Ennis.
21:19The call came in as a four car RTC, road traffic collision.
21:23So you're going to assume the worst.
21:26You're going to assume that the four cars were full of people and they've rolled.
21:31For second year student Anne-Marie, road traffic collisions bring back painful memories of a close friend.
21:38One thing that's always in the back of my mind when I go to RTCs is Michael because he passed
21:44away in that manner.
21:46His ambition was to become a paramedic and he actually asked me to do it with him.
21:51He'd been accepted and he was getting ready to go to college and unfortunately he passed away just before he
21:57was due to start.
21:58So whenever I'm using my stethoscope or whenever I'm on the ambulance with my stethoscope, he's also part of the
22:05journey and he's getting to be a paramedic.
22:09With multiple crews already on scene at the RTC, Anne-Marie is assessing injuries in one of the four cars
22:16involved.
22:17Go to RTC, Anne-Marie, you're attending.
22:18Yeah, I'll take it.
22:20So Rielly, GCS15 alert.
22:23Okay.
22:24Only pain we found is just pain in his neck on the right hand side, right hand side, right hand
22:30side.
22:30Okay.
22:30It's not down midline but there has been back surgery done last year for discs.
22:35Okay.
22:35Okay.
22:36So high impact on a motorway, straight away you're thinking there's going to be spinal damage.
22:44So Rielly, what we're going to do is we're going to take all these bits off you.
22:48We're going to keep the neck cholerae on you just to keep your neck in the same position.
22:52And then we're going to put you onto the vacuum mattress.
22:54That's just to immobilise you further so you don't move anymore until the doctor clears your spine.
23:00All right.
23:00The patient had existing back problems so we took full precautions to immobilise the patient.
23:06We used as many, as much staff as possible to do all the manual lifting so that the patient didn't
23:11have to move.
23:12No pins and needles in the fingers or anything.
23:14No, no.
23:14So what happens, what's going to happen?
23:16Anne-Marie was leading that call for us.
23:18We don't do anything until Anne-Marie tells us.
23:21Yeah, that's good for me there now.
23:24I kind of went the long way around becoming a paramedic.
23:28I was studying and unfortunately my best friend became unwell quite acutely.
23:34It happened quite rapid and she subsequently passed away.
23:39So my head wasn't really in it.
23:41I wasn't really meeting the requirements either.
23:43So I decided to go again and there's a lot of pressure I feel this time round.
23:50I've had to put a lot on the line.
23:52I had to move away from Limerick, go to Ballinasloe to study.
23:55So being back in Limerick is nice and I've also managed to find my own place now.
24:02Which has been quite difficult but I've finally managed to get somewhere.
24:12So this is going to be my new home.
24:16It's small but we'll see now. Hopefully it'll do the job.
24:21For the last year I feel like I've been living in a suitcase.
24:25I don't know if I'm, I haven't had anywhere permanent to kind of really set my roots down because I've
24:31been back and forth to college.
24:33And upstairs I have the master suite.
24:40The place that I've managed to find is in between the two stations that I work at.
24:45And I've had to move into the county of Limerick because living in the city would be just too pricey.
24:54So this is my little sitting room.
24:56Lovely wood burner and couches.
25:00And my kitchen.
25:02I mean it's all very compact but it has everything I need.
25:09Looking forward to putting my own personal touches on it, maybe get a set of drawers and a nice rug.
25:15A few lamps, maybe some pictures.
25:17Yeah, if I can fit it.
25:22Having my own place and work, doing shift work and coming back to my own place and being able to
25:27study in peace and be a bit more independent.
25:30I suppose it's another, it's another milestone that's been reached.
25:33I feel a little bit more settled and a little bit more grounded now.
25:36I'm still cautious because I know that I'm not quite there yet.
25:41I'm not fully qualified yet.
25:42I still have to do the exit interview.
25:44I still have to submit my portfolio.
25:46And I just, I need to keep going and I need to get through it and I need to, yeah,
25:52keep going with it.
26:32It's been a hectic start to student life for Rebecca.
26:35We're not breathing so we just need a King LT.
26:38So just extra set of hands for old and airway for us for a second.
26:41Stepping into an ambulance for the first time as an observer.
26:44Rebecca, so squeeze that bag for me.
26:46One and one every six seconds.
26:49She's had to learn fast on critical calls.
26:52Pressure still holding that 138 over 92.
26:55As well as studying for her assessments in the classroom.
27:09Everybody dreads an OSCE and that's an objective structured clinical examination.
27:14What it is basically to break it down for someone that's never seen it before.
27:18It's a safe place for us to measure whether somebody's competent in the skill.
27:24And that's done within the setting of the colleges.
27:29In terms of prepping yourself for the exams, you'd have your lectures throughout the day 9 to 5.
27:35And then in the evening times you could be in the college up until 7, 8 o'clock in the
27:39evenings running scenarios with your classmates.
27:42Hi, can you tell me your name?
27:44Do you know what happened to you?
27:46No.
27:48Can I ask you a question?
27:50No.
27:52Question is being very difficult.
27:54You're given four lives at the start.
27:56If you fail your OSCE, you lose a life.
28:00And once you had four lives gone then you would have had to have left the programme.
28:05At the Tala campus, first year student Rebecca is preparing for her first ever OSCE, an exam which will take
28:12place in a few weeks time.
28:14Right.
28:14So, scene safe, PPE on.
28:16Any catastrophic hemorrhage?
28:18No.
28:18No.
28:19Okay.
28:19Does anybody see what's happened?
28:20He just passed him down.
28:21I've no first aid, ready to go, so I didn't have no idea.
28:24Okay, right.
28:24Hello, hello, can you hear me?
28:25Any change?
28:27Nope.
28:28No pulse, no breathing.
28:29Okay, no pulse, no breathing.
28:30Phil, will you grab me a BVM there and just leave it at my side?
28:33The first few weeks of college were incredibly nerve-wracking.
28:37You know, you can't help but kind of look around the room and see who's done other pre-paramedic courses
28:43before you and kind of compare yourself and convince yourself that you're like the last one on the list behind
28:48everybody else.
28:49Have we got a good strong pulse?
28:51Yeah, your pulse, you're sitting at about 62 weeks a minute right now.
28:55Continue bagging him on the way into the hospital, obviously.
28:57Anything else you'd like to do?
28:59Erm, 12 lead.
29:02Find the source of the potential arrest.
29:05I just, I'm so glad I'm not in the position that Rebecca is in year one.
29:10I found year one was the toughest.
29:12All her oskies, her short writings, all those, you know, it's such a tough year, but it's tough for a
29:19reason, because they have to prepare you for going out.
29:21I love the way I said to you outside, get the BVM ready first and then put pads on.
29:26And I go, will you get the BVM ready? And I'll not put pads on first.
29:28I was like, I just fucking told you to give it to me first.
29:32Can I panic, okay?
29:34For this scenario, it's important that you just get through the exam because you can't be out on the road
29:38without passing the exam.
29:44Today, she's back on the road with Cuiva and Greg as number three, and is now expected to take on
29:50more responsibility as her training intensifies.
29:54Rebecca, we have a 72 year old male in a GP surgery, shortness of breath, high temperature, most likely infection,
30:01chest infection, respiratory infection.
30:03The doctor will generally give a comprehensive handover.
30:05They'll generally tell you about the patient because most likely they know the most likely this is their local GP.
30:10But it's important we still ask the patients the questions and it's not disrespectful to the doctor.
30:14It's just that we have to ascertain it ourselves also.
30:17I think it was the first call I'd ever been to where a GP had rang for an ambulance.
30:22I was thinking about the fact that I would have to take a handover, a clinical handover from the GP.
30:27We had kind of said to Rebecca, you take the lead on this now and you know, it's a nice
30:32call.
30:32You're going to get great medical history. There's going to be no guessing or anything like that because we'll all
30:37be very clear.
30:39Do you want me to attach his legs because that might catch on you?
30:42No, we're missing the thing off.
30:43Oh, you're missing the thing off.
30:43You just glide me over this bump, will you?
30:45Yeah.
30:46You might need a hand.
30:46Yeah, you just take the bottom of it.
30:48Now turn around, do a proper break, give your bag to me.
30:52There you go.
30:52Yeah, perfect.
30:53Thanks.
30:55And then it was a matter of into the ambulance and focusing on what the patient needed.
30:59Whether he needed medication to help him breathe, you know, did he have any chronic conditions like asthma or COPD.
31:04And what we could do to help him before we got him to the hospital.
31:11Sorry, Rebecca, I'll give that to you.
31:13Yeah, no problem.
31:14Just get the side of the stretcher down, have the stretcher prepped.
31:16Yeah.
31:17OK?
31:18Ready, steady, lift.
31:23You all right?
31:24Yeah.
31:25Have you been coughing much up?
31:28Oh, on for the last month.
31:29Oh, no.
31:31It comes, I mean, you think you're getting better.
31:33I know, and it comes back again then.
31:36OK.
31:36I haven't got COVID.
31:38I haven't checked for anything.
31:39And are you a smoker?
31:41What?
31:41Are you a smoker?
31:42Oh, no, no, no, no.
31:43I ain't smoking.
31:44Right, OK.
31:46So, Rebecca, so you have to be mindful, Rebecca, of your position.
31:49So you should be down this end to help Quiver transfer over.
31:52No, you sit down there.
31:52OK.
31:53So you have to be mindful of that, OK?
31:54Yeah, yeah.
31:54We're done with prep work, so we're going to work on that today.
31:56Yeah.
31:59There's a bit of a jump between the seven-week and the 15-week placement, so you're feeling
32:04that bit more qualified, which is quickly wiped out as soon as you get out onto the road
32:10again, you know you're kind of brought back into reality.
32:13I'm going to take that off for a second.
32:15We'll do seatbelts before we do monitor because with these seatbelts it gets cost.
32:19Yes, no problem.
32:20You get all tangled, so you're better off having them on.
32:22And that was the learning from the last call?
32:25OK.
32:25Seatbelts before monitor Quiver set you?
32:27So we have to keep that in mind, OK?
32:28Yeah.
32:28So each call is a learning call, each call is a development call, and there are milestones
32:32you have to meet each call.
32:33OK.
32:34With the new stretchers that we have, we always say, you know, put the seatbelts on first and
32:38the monitor on afterwards because that way then it doesn't all get tangled up in between.
32:43And so there's a few little things like that that was just, would make her day easier and
32:47would make her calls easier and would make it more comfortable for the patient.
32:51It all just seems like run-of-the-mill stuff, but if it's not done, then you'll just run
32:56into difficulties later on.
32:58The doctor was saying you've had a few problems with your heart, have you?
33:01I had a big heart operation a few years ago.
33:03Oh, did you?
33:04OK.
33:04Right.
33:05I'm just going to take your temperature.
33:06You keep going.
33:07Work around.
33:07We'll do it at the same time.
33:1037-8.
33:13It's not connecting, is it now?
33:15No.
33:17Just sometimes a t-shirt can cause them to come up.
33:19Yeah, this one's not on.
33:22It gets caught in the clothes sometimes, that's all.
33:26Everybody I've worked with, they've all been able to teach me a lot.
33:29I feel like I wanted to perform well as well for Greg.
33:33Like I didn't want to come across like a fool.
33:39We got him from his GP today.
33:41How are you doing?
33:42He's been coughing for about a month.
33:43And he was hypertensive.
33:45Today?
33:45Yeah, today.
33:47Now he's 38 in the ambulance with us, but he was 38.8 in the GP's office.
33:50He has mild pitting edema in his legs and that's new.
33:53Well, I asked him, had he ever noticed that before?
33:56It's an obvious wheeze on auscultation.
33:58Now he does have a history of stroke.
34:01With the patient safely handed over at hospital, Greg leads a post-call debrief.
34:07Patient is paramount.
34:09Patient is priority.
34:10And saying yeah is okay, doing it on the next call is concrete.
34:15That's the difference, okay?
34:16Because we can all say yeah and not our head, but if I don't know it's not going in,
34:20it means the parting knowledge that we're giving to you to nurture you,
34:23to develop you into the paramedic of the future is not happening.
34:27Next call, we'll build on what we learned in this call.
34:30Patient assessment wise, you didn't really do one, okay?
34:33You got a good clinical handover from the doctor.
34:35We've done everything else.
34:36You gave actually a stunning handover inside.
34:38Really good.
34:38So that part, really good.
34:40But I need to get the part where it all happens.
34:44I need you to do that part.
34:46Obviously after the call, there was criticism from Greg,
34:49which is expected, you know, you're on your seven weeks.
34:51I expect it to be criticized after every call.
34:54Because if you can't, then there's zero point in you being out on placement.
34:59Do the assessment, do the clinical diagnosis,
35:02then give the clinical handover.
35:03So part A, excellent.
35:05Part C, excellent.
35:07Let's work on part B.
35:23You're going on holidays anywhere, are you?
35:26Well, I went to Tenerife in January with the Lasby College.
35:30And I went to Belfast Dublin and Marseille in there two weeks ago.
35:36So, the three places?
35:38Yeah.
35:39So that was a bit of crap.
35:43In Castle Bar, second year student Ryan is on shift with advanced paramedic Tommy.
35:50Tommy's a gentleman.
35:51Obviously as an AP, he brings a more broader spectrum of skills to the table.
35:57And in fairness to him, he'll tell you how it is.
35:59If you've done something wrong, he'll say it to you.
36:02And you need that.
36:03You need somebody to tell you how it is.
36:05Because that's the only way you're going to progress as well as a practitioner.
36:09The French are very direct people though.
36:12And it's more bumping cars over there now than anything.
36:15Where's the miss where the eight roads come into Devon?
36:18Oh, is that in Tars?
36:21Yeah.
36:21Yeah.
36:23At work, we clock up a fair few miles and we see a lot of beautiful views around the county.
36:27But yeah, I suppose long journey times in countrysides.
36:34Being a paramedic or advanced paramedic in Mayo, it's a very vast area.
36:39So we could get a call in Achill and our very next call could be in Balahadrine.
36:44So it's a massive area.
36:46But the majority of our calls and a lot of our calls seem to be elderly patients.
36:51Today, the lads are responding to a call where an elderly lady has fallen at home.
36:56Irene.
36:57Hey, how's it going?
36:58How is keeping?
36:58What's your name?
36:59Tony.
37:00Tony.
37:00Are you related to...?
37:01Yeah, next to Kim, yeah.
37:05Are you able to turn your head left and right for me?
37:07I am.
37:08And any pain with that at all?
37:09No.
37:1089-year-old Irene, who lives alone, hasn't been able to move since falling a couple of hours ago.
37:16And where's your pain at the moment?
37:18My two knees that are always...
37:20They're always sore.
37:22They're always sore.
37:22Oh.
37:23I wouldn't be a good footballer.
37:25Oh, God love you.
37:25Or denser.
37:27Well, I wouldn't be far behind you, Irene.
37:29I'm not greater than myself.
37:30Two left feet, yes.
37:31I'd be a good talker anyways.
37:33So I would.
37:35I'd talk the donkey off the horse's back, so I would.
37:37So, yeah.
37:40You're swimming against the tide straight away if you can't build a rapport with the patient.
37:44Do you remember falling?
37:45Oh, I do.
37:46I knew I was going.
37:47You didn't hit the head or anything, did you?
37:49Will you have a look at me for a second, Irene?
37:51I just want to have a look there.
37:53You like to look at me.
37:55Oh, don't be telling him that.
37:57Don't be flattering me now.
37:58I'm flustered here and that was enough, so I am.
38:02Yeah, certainly flirtatious commentary.
38:06But lookit.
38:07Life's too short, you have to have a laugh sometimes if you do.
38:10Will you wiggle your toes there for me for a second?
38:13Yeah.
38:13Which foot am I touching?
38:14Left.
38:15Any pain in your hip at all here?
38:17No, nothing.
38:18You had a hip replacement?
38:19Yeah.
38:20Which one?
38:21The left one.
38:22Okay.
38:23We did initial assessments on her just to rule out any serious injury,
38:28from the fall and just kind of gathered a patient history as well
38:31in terms of the events leading up to the fall as well.
38:35So after assessing her then and doing the few bits with her blood pressure
38:38and that kind of thing, we were happy enough to sit her up
38:41and get her up off the floor.
38:43What we'll do is try and bend up your two legs if you can.
38:46We'll sit you up a bit and then try and bend up the knees if you can.
38:49You ready?
38:49Yeah.
38:49One, two, three.
38:51Oh, God bless you.
38:52That's the one.
38:54She had a minor wound on the bridge of her nose as well.
38:58So she's obviously suffered some minor trauma there on the way down to the ground as well.
39:03When we're doing kind of an assessment of a home house as well,
39:06especially with the elderly population,
39:09we're looking for risk factors and trying to mitigate those
39:11so that falls and trips don't, you know, there's less risk of them happening again.
39:17We'll throw the legs up to Irene if you can at all.
39:19Hands across your chest if you can.
39:20I'll hold your hand if you like.
39:46And so what you should do yourself back in the day?
39:49It's a nurse.
39:50A nurse.
39:51I worked in Mayo General.
39:54Oh, right.
39:55I don't think anyone there, I don't know anyone there now
39:58because it's a good many years since I left.
40:01And were you long in the nursing field then were you?
40:03Oh, God, I went to England at 17 and I started my nursing there.
40:10Yeah.
40:10I worked there for a few years and then I went to New York for a few years.
40:15Very good.
40:16It's a nice sentiment to think that she gave so many years of service caring for people
40:21that the service is now being returned to her in her time of need as well.
40:27Just at the moment anyways, Irene, all your vitals are perfect.
40:30Your heart rate, your oxygen levels, your blood pressure.
40:33There's nothing on earth there at the moment.
40:35I'm very healthy, thank God.
40:37My age.
40:39I tell you, you had me fooled.
40:40I thought you were in your seventies.
40:41Oh, thank you.
40:46How was that?
40:47You can slow down a little.
40:49Oh, well, thank you very much.
40:51Yes.
40:53He's up on the right foot.
40:55Well, this is it, Irene.
40:57Huh?
40:58Can I give these bits to you?
40:59All right?
41:00Your tablets there.
41:01Is that all right?
41:02Put this blanket up around you.
41:03Do you want to pop the two arms in?
41:04We'll keep you nice and warm.
41:06Oh, that's lovely, God.
41:07No.
41:18A few bumps coming out here, Irene.
41:20Huh?
41:20A few bumps.
41:22So, Ryan performed quite well on that call.
41:24He had great communication and great compassion towards her
41:27and carried out his good assessment
41:29and then continued that as he conveyed her to the hospital.
41:34So, you going to check in?
41:37Thanks.
41:45Having spent time on the road with the crew
41:47and months training in college,
41:49Rebecca is arriving for her OSCE,
41:51where she'll be tested in a range of simulated scenarios
41:54with a classmate.
41:57Go through sample, go through the seven rites
42:01and then reassess everything.
42:03Yeah, just reassess ABC and then go to the hospital.
42:06Perfect.
42:07For long-term pain relief, I'm considering ibuprofen
42:09and how's these ones?
42:10Yeah, grand.
42:11Perfect.
42:12We have our OSCEs, which are the practical exams.
42:16Everybody is kind of different, mixed emotions.
42:20You know, some people are really nervous, some people are completely comfortable and confident.
42:24I'm kind of a unique case because I have a real fake it till you make it kind of approach
42:29to it.
42:29So, you have to convince yourself you're not nervous at all.
42:33If you get abdominal pain and it's positive, remember to ask, do you still have your appendix?
42:38Okay.
42:38Yeah.
42:38And bowel movements.
42:40And bowel movements too.
42:41How's your bowel movement been?
42:42Oh yeah, I didn't even do that.
42:44We all have the same end goal of passing at the end of the day.
42:47So, I think it's really important, like nobody wants anybody to be left behind.
42:52So, we're all kind of doing a group effort to get everyone over the finish line.
42:56Anything you don't want, leave it in there, guys, and then we will.
43:00So, I think it's really important, you know, during exams to remind yourself of all the training you've done
43:06and kind of fall back on that.
43:08You know, if you've done the prep for it, then you should be fine.
43:21Start assessment.
43:52Next time.
43:56We better go.
43:58It's cardiac.
44:02Where's that catch?
44:03This side.
44:05Over here?
44:06Yeah.
44:07It's alright, we'll do it all the way.
44:11Where are we?
44:25Okay.
44:27That's it.
44:33Yeah.
44:33No, no.
44:39Genесть and Ironically, dance.
44:40You
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