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00:07It's one of the most pressurized 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 welcomes around 90 new hopefuls to their campuses in Dublin, Balnaisloe, Tullamore and
00:34Cork.
00:34These people here are going to be your absolute backbone for the next three years.
00:40But not everyone makes it true.
00:42I don't think I'm going to do this anymore.
00:45Just shit, like, I'll go to that in two days.
00:48Because this is no ordinary degree course.
00:51Where are you going to go?
00:52It's cardiac.
00:57These students are out in ambulances across the country.
01:00999, mode activated.
01:05Learning on real emergency calls.
01:07Here, here, here, here.
01:08It's over there.
01:11With every shift a crash course in courage.
01:14It doesn't get any harder than this.
01:16Resilience.
01:17And critical decision-making.
01:20We have a device that brings the bones back into place, but it's going to cause them to scream.
01:23Big deep breath for me.
01:25The exams on this course aren't just a pass or fail.
01:29Uh, 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.
01:36I'm not breathing.
01:53Patients inside the house, I just come across, they're confusing, but the call is outside the house and can't get
01:58into the patient, everybody.
01:59Oh, that's sound 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.
02:13Because you have the question like this, bing, bing, bing, bing, bing, straight away.
02:16And I just need a minute to think of the question.
02:18I will get to where I need to be.
02:20Okay.
02:21But it'll just take me a wee bit longer than I say.
02:23I will be nice and quiet.
02:25Okay.
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 buildup of fluid in her lower limbs.
02:40Eight, nine.
02:42It's been here, is it?
02:44Right.
02:46And her mobility had been reduced the last number of weeks.
02:52Hello, ambulance service.
02:55Are you talking to her now?
02:56No.
02:57It's normally her sister who comes to her.
02:59Hello.
03:02When we arrived at the address, we were met by the patient's next to Cain.
03:06Hello.
03:07We 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,
03:21given that there was a concern for life
03:24and 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.
03:31Come on, Ryan.
03:34We went round to the back of the property.
03:36Big high wall.
03:37I'm not quite as athletic as Ryan.
03:40I'm younger than you.
03:41Do you want me to try?
03:43Just go down there on your hands and knees and then stand on your back.
03:46Oh, yeah.
03:46This is marvelous now.
03:47Jesus, will you mind yourself?
03:48Will 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.
03:56And...
03:58And, 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.
04:11Oh, Christ.
04:17Is it locked?
04:18Yeah.
04:19Right, come on.
04:20Again, the back door was locked,
04:21so we contacted the guardie 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.
04:31Concern for welfare.
04:32Yeah.
04:33And acting in the best interest of the patient.
04:35That's the two things for getting on access.
04:40The guards couldn't advise of an ETA,
04:42and there was a concern for life from our end
04:44because the patient was now not responding to our requests.
04:48With the ambulance service,
04:51so can you come out and open the door,
04:53or we're going to have to push it in?
04:56Again, tried multiple times banging on the door,
04:59shouting 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,
05:09is there something seriously wrong here?
05:11Why is this lady not answering us?
05:13Hello?
05:14How are you?
05:16So, look, I can probably push the door in.
05:18I made the decision that we were going to put the door in,
05:21but, again, I asked for permission first,
05:24if you think it's OK,
05:25and we got permission to put the door in.
05:41Like Ryan, 31-year-old Nathan,
05:43is also a second-year student,
05:45officially titled as an intern paramedic.
05:47How do you think your internship is going?
05:50Six months in,
05:51it seems to be going well so far.
05:54It's been a good mix of the normal, everyday calls,
05:58and then the old year calls.
06:03I'm out of my 52-week placement now
06:05as a paramedic intern,
06:06and that's kind of when the really hard work starts
06:09and the proper learning starts
06:10because I'm learning from the crews I'm on with.
06:14Training for a sport,
06:15it's not until you're in the county final
06:17that, you know, there's training and there's match fitness.
06:21Yeah.
06:22And, like, what they're doing in the college is, like,
06:25training,
06:25but that's when you're on the road,
06:27that's when you need to match fish bearings.
06:29And then also we have our kind of on-the-road assessments
06:32to throw in,
06:34and it's been tough because I'm now rostered
06:36instead of just going to a college
06:38where I'm Monday to Friday,
06:39kind of nine to five.
06:40It's days and nights
06:42and 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
06:47to kind of juggle all of that.
06:54Today, Nathan and advanced paramedic Declan
06:57are responding to an emergency call in New Ross,
06:59where a woman has fallen outside her home.
07:03So this is 40-year-old Jenny,
07:04just a simple follow over the door,
07:06just an injury to the left ankle.
07:09On arrival to the call,
07:10we found out that there was actually an off-duty
07:12advanced paramedic
07:13who lives fairly close by
07:15and his friends with this patient was on scene.
07:17So Paul was already there,
07:19and because Paul is an advanced paramedic supervisor,
07:22he was able to run up to the New Ross ambulance station,
07:25pick up a drugs bag
07:26and come back down
07:27and kind of start
07:28kind of the initial treatment.
07:29There is a bit of a wound there
07:31from where it hit the ground.
07:32You didn't do anything with it
07:33as you've just splinted in Pentrox.
07:35Pain score up around eight when I arrived.
07:38Pain score zero or ten now.
07:39We have quite a lot
07:41that we can do as paramedics
07:42when it comes to pain relief now.
07:44We have Entinox,
07:45we have Pentrox,
07:46we have Paracetamol, Lipoprofen,
07:47and to have that kind of started there
07:50already when we got there
07:51is a kind of big
07:52kind of weight off our shoulders.
07:54How long has she had the Pentrox for?
07:56Just literally,
07:57what 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.
08:05Take your finger off the top of this
08:06for a few minutes
08:07and you can keep taking it
08:08without the finger on the top.
08:09Okay.
08:10All right, good woman.
08:10I wasn't that meant to be.
08:11No, no,
08:12it's just you get a little bit
08:13of a stronger burst
08:14when you put the finger on top
08:15and I think you might have
08:16had strong enough a burst.
08:18The Pentrox had started to kick in.
08:20Pentrox can be quite an interesting
08:22medication to give people
08:23because it can make you
08:24quite funny sometimes.
08:25It can make you seem like you're drunk
08:27and it was certainly
08:28having that effect with Jenny.
08:31She was definitely getting
08:32the full advantage of the Pentrox.
08:34It was definitely doing its job.
08:37and I saw my garden.
08:38She was just probably stinking.
08:40Give me a favour.
08:41Bend up that leg.
08:42I don't need the other one.
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
08:49when I go home?
08:52Just like five or ten.
08:53Just a spare one.
08:54I'm the spare one.
08:55Just five or ten.
08:56Thank you so much, lad.
08:58Well, all right.
08:59And, lads,
09:00do you know what the worst thing
09:01about it all is?
09:02What?
09:02That I'm going to the Coors
09:04tomorrow.
09:05How are you?
09:05The Coors?
09:06A couple of bottles of Coors.
09:10That's as close
09:11as you're going to get down now.
09:13All of those are the most amazing people
09:15that I used to love.
09:16All Jenny was worried about
09:17was going to a Coors concert.
09:20We kind of realised
09:21between ourselves
09:22that she probably
09:22wouldn't be going.
09:25It's not a strong.
09:26Probably best not to.
09:27I don't mind things like that.
09:30Can I just have a look now?
09:32Can you get it?
09:32Get in, is it?
09:33Take some deep breaths.
09:34Oh, no, I can't.
09:35Oh, that is it.
09:38Have the pulse marked on it there, Dickie.
09:39You can just recheck it.
09:42Toes are Coors.
09:43Three, four.
09:45Here's where this kind of call
09:46becomes dangerous.
09:47Jenny's ankle had been
09:49completely dislocated
09:50from the joint
09:51that it's meant to be in.
09:52And it might even require
09:54resetting it.
09:54Dickie, it was about a tree
09:56when I assessed the pulse.
09:56Yeah, I was about a five now,
09:58at least a five now.
09:59And I can't feel no pulse.
10:12In Castle Bar,
10:14second-year student Ryan
10:15and advanced paramedic Tommy
10:16have gained entry
10:18into the home
10:18of an elderly lady
10:19over concerns
10:20for her welfare.
10:25We went in expecting
10:27to see a patient
10:29unresponsive on the ground,
10:30but the lady was sitting
10:32in the corner
10:32listening to a radio station
10:35so there was music playing.
10:38How are you?
10:40Why did you break my door?
10:41I asked you to answer me
10:42and I thought you'd fail
10:43or something had happened to you.
10:44Where?
10:45You have to see
10:46how we're concerned about you.
10:47No.
10:51My name's Ryan.
10:52I'm with the ambulance service.
10:53I have people.
10:54I don't want to go.
10:56I go to the doctor
10:56any one time
10:57and that's all.
10:58She did not want
10:59to go to hospital
11:00and was quite direct
11:02about it as well.
11:06Your legs are quite swollen.
11:08Yeah.
11:09I think, like,
11:10it might be no harm
11:11to come in
11:11and get your legs.
11:12All right, now, no.
11:14Okay.
11:14My sister's bringing me in.
11:16Is she?
11:17Yes.
11:17Can we ring your sister?
11:18No.
11:20Why do you want to know
11:20what this person is?
11:22Because...
11:23When I'm going, anyway.
11:24Yeah, but we don't know that.
11:26I'm honest.
11:27Take my work.
11:28So Ryan,
11:30as he always is,
11:31is the good cop
11:31and then I just had to be
11:32the bad cop.
11:34The way it is,
11:35I don't think you've
11:36made an appointment
11:36to the doctor
11:37and with all that
11:38swelling of the legs,
11:39that's all backing up.
11:40It's all putting pressure
11:41on your heart
11:41and that's where
11:42all that fluid goes
11:44and there is a risk
11:45with all that fluid
11:46that your heart
11:46gets under too much pressure
11:47and you could die.
11:49Come into the hospital,
11:50get your medication,
11:51get the legs
11:52back under control
11:53and then you'll be able
11:54to move around here
11:55more comfortably.
11:56I am not good.
11:58There was no way
11:59she was going to hospital
12:00and she really needed to
12:01and I explained the reasons
12:02as far as I explained
12:03why she possibly
12:04needs to go.
12:05Tommy has already
12:06outlined risks
12:07of not coming with us.
12:08Do you understand
12:09those risks?
12:10I have nothing
12:10to say to you.
12:11But you need to repeat
12:12back to us that you
12:13understand that you
12:14could die.
12:14You need to say that
12:15back to us.
12:16What's the risk?
12:19Die and die.
12:23It's hard to walk away
12:24because then you're thinking
12:25oh what if something
12:26happens in the next while
12:27and then it's always there
12:28oh the ambulance
12:29was out a while ago
12:29why didn't they take her in
12:30and eventually it comes
12:32to a point where
12:32a decision has to be made
12:33it's either yes or no
12:34are you going to let us
12:35or not let us.
12:36At the end of the day
12:37we cannot kidnap people
12:38we have to respect
12:39a patient's autonomy
12:41and their decision
12:42to be wrong
12:43their right to be wrong.
12:48In Wexford
12:49second year student Nathan
12:51is treating Jenny
12:52who had been looking
12:53forward to a Coors gig
12:55before she fell
12:56and suffered a bad
12:57fracture of her lower limb.
12:58Once we took it off
12:59we realised that
13:00it was a little bit more
13:01than just a simple
13:02kind of fracture
13:03it was actually
13:03a fracture dislocation
13:04and it was starting
13:05to cut off some
13:06blood supply.
13:09Because the blood supply
13:10is a teeny tiny
13:11little bit slow
13:12we want to try and
13:13get that back
13:14blood supply back
13:14again by putting it
13:15back where it's
13:16meant to be.
13:17Alright.
13:17The foot.
13:18The foot.
13:19They're going to call
13:20a doctor in Cork
13:21basically explain
13:22what's going on.
13:22Well the Coors
13:22are in Cork tomorrow.
13:24So I could go there.
13:26Without urgent
13:27intervention on scene
13:28Jenny is in danger
13:30of losing her foot.
13:32So it's going to be
13:33a little bit of
13:33pulling and dragging.
13:34That's okay.
13:34Alright.
13:35It might feel very strange
13:36but you won't remember it
13:37as Dickey said.
13:38I don't mind that.
13:39I'd like to class myself
13:40as kind of knowing
13:41what was going to happen
13:42with dealing with
13:43a fracture
13:44and dealing with
13:45certain things
13:46but this is now
13:47out of my
13:47kind of
13:49bag of tools
13:50this is
13:50getting into
13:51higher kind of
13:52clinical territory
13:53and I knew that
13:54my job now
13:55was to
13:55just try and have
13:56explain what was
13:57going on to
13:58the patient
13:59and also kind of
14:00explain what was
14:01going on to myself
14:01a little bit.
14:04now cocktail hour
14:05lovely
14:06this is what
14:07they give horses
14:08not this stuff
14:10I'm just going to
14:10give you another
14:11little bit of
14:11pain relief first
14:12lovely
14:14and then I'm going to
14:15give you the stuff
14:15to give to the
14:16donkeys
14:16oh lovely
14:18I'm a real ass
14:19anyway
14:20members of the
14:21public
14:21know ketamine
14:22as the horse
14:23tranquilizer
14:24in an ambulance
14:25it's used
14:26and much lower
14:27dosages
14:28obviously
14:28it's still
14:29effectively the
14:30same drug
14:30but it's not
14:31used for the
14:31same reasons
14:32as a vet
14:33would use it
14:34all right then
14:35I'm all right
14:36good girl
14:37yeah
14:37you might feel
14:38a little bit
14:39weird now
14:39but
14:39doesn't matter
14:41it won't be
14:42unusual for you
14:42don't think
14:43there's no pain
14:43what
14:44you're saying
14:44I'm weird
14:45hey I can still
14:47understand things
14:49you're all right
14:50yeah I'm starting
14:51to feel weird
14:52yeah good girl
14:52off I go
14:53bye Dan
14:55I'm going off
14:56now
14:56all right then
15:01Jenny
15:01all right
15:02just look at that
15:03turn around
15:07you can squeeze
15:07my hand there
15:08that's it
15:09well done
15:09now we'll keep
15:10tension
15:10I mean just pull
15:11that down this way
15:12and once you
15:14relocate something
15:14like that
15:15it's going to
15:16there's going to be
15:16possibilities of
15:17a fracture there
15:18and she would
15:19probably end up
15:20going for surgery
15:21can you wiggle
15:22those toes
15:22no no no
15:24does that feel
15:25any better since
15:26before we popped
15:27it back into place
15:28you didn't
15:28talk back
15:29we did yeah
15:30when
15:30we knocked you
15:31out for a few
15:31minutes and popped
15:32it back into place
15:33oh that's
15:34bloody brilliant
15:35are you messing
15:36no
15:36here's me thinking
15:37I was the right
15:38one now you
15:39knock me out
15:40did you
15:41mommy
15:42seriously
15:43seriously
15:44you're all
15:44started
16:07in Dublin
16:08second year student
16:09Aoife and
16:10experienced
16:11paramedic Rory
16:12have been called
16:13to a suspected
16:14cardiac arrest
16:15at a housing
16:15complex
16:21I'd say down
16:22here
16:24so obviously
16:25when we arrived
16:25on scene
16:25we were trying
16:26as quickly
16:26to get all
16:27the equipment
16:27out and get
16:28to see him
16:29but we were
16:30met by a member
16:31of DFB
16:31who informed us
16:32that he was
16:33dead in arrival
16:36despite being at
16:37the scene
16:38within minutes
16:38of the call
16:39coming in
16:40it's clear
16:40the man
16:41had been
16:41already dead
16:42for several
16:43hours
16:44who called in
16:48we entered
16:49the property
16:50it was quite
16:51unkept
16:52it was very
16:53dirty
16:53evidence of
16:54drug use
16:54all over the
16:55house
16:55sharps
16:56everywhere
16:57and before we
16:58enter the scene
16:59we look for
17:00scene safety
17:00so scene safety
17:01is something
17:02down as far
17:02as putting
17:03your gloves on
17:03goggles
17:04gown
17:04that kind of
17:05stuff
17:05as well as
17:06before you
17:06actually step
17:07into the room
17:08you have a look
17:09around the room
17:09and see is there
17:10anything that
17:10could be a hazard
17:11to you or your
17:12colleagues
17:12or anybody else
17:13that might be
17:13coming in the
17:13door behind you
17:15in that particular
17:16scene
17:16there was sharps
17:18everywhere
17:19we'll do a quick
17:19trace just to make
17:20sure everything
17:21is what it is
17:22so you put on
17:23the monitors
17:24to check if he
17:24has a pulse
17:25or he has a heart
17:26it could be
17:27checks pupils
17:28see if his pupils
17:29are reactive
17:29if they're fixed
17:30if he has any
17:31breath sounds
17:33pupils are fixed
17:35fixed
17:35colds
17:36pooling
17:36everything
17:38it's quite
17:39upsetting obviously
17:39to see the poor
17:40standard of living
17:41that the patient
17:42had had
17:42and I suppose
17:44heart brains
17:44think that we've
17:45lost another life
17:46to possible
17:47drug overdose
17:50people don't
17:51decide one day
17:52that they just
17:53want to do drugs
17:53they fall in
17:54with the wrong
17:55people maybe
17:55and it's an
17:56addiction
17:56it just gets
17:57worse from there
17:58they might have
17:58an awful lot
17:59going on
17:59that we don't
17:59know around
18:00in the background
18:00so mental health
18:01could be a bit
18:02of an issue
18:02there
18:02and the problem
18:04with drugs
18:05is it's an addiction
18:06and it's a worsening
18:07addiction
18:08so the more you do
18:09the more you need
18:10the risk is
18:11that you might find
18:12yourself alone
18:13and nobody's there
18:14to help you
18:15and if you use too
18:16much of the medications
18:17or drugs
18:19the end result
18:20is the end of the line
18:21it's death
18:22no matter how often
18:23you do those calls
18:25they're always going
18:25to be upsetting
18:26that's somebody's
18:27child
18:28that's potentially
18:29somebody's partner
18:30or father even
18:32you know
18:33and he's young enough
18:35I'd say approximately
18:3540 year old male
18:36so yeah look
18:39it is upsetting
18:39and not just for me
18:40obviously for
18:41an extended family
18:42somewhere
18:42they're getting
18:43some bad news
18:43now shortly
18:44you know
18:49for paramedics
18:50all over the country
18:51dealing with death
18:52is a difficult
18:53but inevitable
18:54part of the job
18:57it can be tough
18:58for us
18:58I'm doing this
18:59a long enough time
19:00now at this stage
19:00I've seen a fair share
19:01of them
19:02it doesn't really
19:03get any easier
19:05it can be emotional
19:06it can be hard
19:07especially for anyone
19:08who's brand new
19:08into the job
19:09and they've never
19:10seen it before
19:14sometimes
19:14there's calls
19:14we arrive to
19:15and there's nothing
19:17that we can do
19:17and sometimes
19:18you have to just
19:19take a step back
19:19and maybe go
19:20be the person
19:21to go do the paperwork
19:22in the back of the ambulance
19:23and take a minute
19:25I had one big call
19:27where I had huge questions
19:29after it
19:30whether I was
19:31the right person
19:32for the call
19:33it was a paediatric arrest
19:35and it had a sad outcome
19:40it's that fear
19:43and that self
19:45doubt you have
19:46that you're not
19:47quite good enough
19:48dealing with the call
19:49amongst your colleagues
19:50talking with it
19:51amongst your colleagues
19:51is the most important thing
19:52don't ever bring those calls home
19:54don't try to deal
19:55with them yourself either
19:56because we're not meant
19:57to process things like that
19:58really are we
19:59you know
19:59at the end of the day
20:01nobody's meant to see
20:01those kind of things
20:02you know
20:03we need to mind ourselves
20:04and each other
20:09we've had a lot of drug related calls
20:11lately haven't we
20:12yeah the whole of yesterday
20:15was all drugs
20:16alcohol related
20:17you know
20:17it seems to be
20:19a growing trend
20:20and it seems to be
20:21getting worse at the moment
20:22but just too late
20:23for that gentleman there
20:24and
20:25you don't wish that on anyone
20:27you know
20:27so
20:28just
20:29too little too late
20:30for him I suppose
20:30very excited
20:31yeah
21:02we're just getting more details here now
21:06four car RTC
21:07two to three cars
21:08in one van
21:10it came in from fire control
21:11so somebody obviously rang
21:12the fire service
21:13so there's an ambulance
21:14almost there
21:15for a minute
21:19the call came in
21:20as a four car RTC
21:22road traffic collision
21:23so you're going to assume
21:25the worst
21:25you're going to assume
21:26that the four cars
21:28were full of people
21:29and they'd row
21:31for second year student
21:33Anne-Marie
21:33road traffic collisions
21:35bring back painful memories
21:36of a close friend
21:37one thing that's always
21:39in the back of my mind
21:40when I go to RTCs
21:42is Michael
21:43because he passed away
21:45in that manner
21:45his ambition was to become
21:47a paramedic
21:48and he actually asked me
21:49to do it with him
21:50he'd been accepted
21:51and he was getting ready
21:52to go to college
21:53and unfortunately
21:54he passed away
21:56just before
21:57he was due to start
21:58so
22:00whenever I'm
22:00using my stethoscope
22:01or whenever I'm
22:02on the ambulance
22:03with my stethoscope
22:03he's also
22:04part of the journey
22:05and he's getting
22:06to be a paramedic
22:09with multiple crews
22:10already on scene
22:11at the RTC
22:12Anne-Marie is assessing
22:14injuries
22:15in one of the four cars
22:16involved
22:17Anne-Marie
22:17you're attending
22:17yeah I'll take
22:18so Anne-Marie
22:19you want to take it in
22:19so Wiley
22:21GCS 15
22:22alert
22:23okay
22:24only pain we found
22:26he just came
22:27his neck
22:28on the right hand side
22:29and his side
22:29the right hand side
22:30okay
22:30it's not down midline
22:31but there has been
22:32back surgery done
22:33last year
22:34for discs
22:36so high impact
22:37on a motorway
22:38straight away
22:39you're thinking
22:39there's going to be
22:40spinal damage
22:44so Riley
22:45what we're going to do
22:46we're going to take
22:47all these bits off you
22:48we're going to keep
22:48the neck cholera
22:49on you
22:50just to keep your neck
22:51in the same position
22:52and then we're going to
22:53put you onto the vacuum
22:54mattress
22:54that's just to
22:55immobilise you further
22:56so you don't move anymore
22:57until the doctor clears
22:59your spine
22:59all right
23:00the patient had
23:01existing back problems
23:03so we took full precautions
23:04to immobilise the patient
23:06we used as many
23:07as much staff as possible
23:08to do all the manual lifting
23:09so that the patient
23:11didn't have to move
23:11no pins and needles
23:13in the fingers or anything
23:14no no
23:15Anne-Marie was leading
23:17that call for us
23:18we don't do anything
23:19until Anne-Marie tells us
23:21yeah that's good for me
23:22down out
23:24I kind of went the long
23:26way around
23:26becoming a paramedic
23:28I was studying
23:30and unfortunately
23:31my best friend
23:32became unwell
23:33quite acutely
23:34quite happened
23:35quite rapid
23:36and she subsequently
23:37passed away
23:38so my head wasn't
23:40really in it
23:40I wasn't really
23:42meeting the requirements
23:43either
23:43so I decided to go again
23:45and there's a lot
23:47of pressure
23:48I feel
23:49this time round
23:50I've had to put a lot
23:51on the line
23:52I had to move away
23:53from Limerick
23:53go to Ballinas Low
23:54to study
23:55so being back
23:57in Limerick
23:58is nice
23:59and I've also
24:00managed to find
24:00my own place now
24:01which has been
24:03quite difficult
24:03but I've finally
24:05managed to get somewhere
24:12so this is gonna be
24:14my new home
24:16it's small
24:16but we'll see now
24:18hopefully
24:18it'll do the job
24:21for the last year
24:23I feel like
24:24I've been living
24:25in a suitcase
24:25I don't know
24:26if I'm
24:26I haven't had
24:28anywhere permanent
24:28to kind of
24:29really set my roots down
24:30because I've been
24:31back and forth to college
24:32and upstairs
24:34and upstairs
24:35I have
24:36the master suite
24:40the place that I've
24:41managed to find
24:42is in between
24:43the two stations
24:44that I work at
24:45and
24:46I've had to move
24:47into the county
24:49of Limerick
24:49because living in the city
24:50would be
24:52just too pricey
24:54so this is my
24:55little sitting room
24:56lovely wood burner
24:58and couches
25:00and my kitchen
25:01I mean it's all
25:03very compact
25:03but it has everything
25:04I need
25:09looking forward
25:09to putting my own
25:10personal touches on it
25:11maybe get a set of
25:12drawers
25:13and a nice rug
25:15a few lamps
25:16maybe some pictures
25:17yeah
25:17if I can fit it
25:22having my own place
25:23and doing shift work
25:25and coming back
25:25to my own place
25:26and being able to
25:27study in peace
25:27and be a bit more
25:29independent
25:30I suppose it's another
25:31milestone that's been reached
25:33I feel a little bit
25:34more settled
25:35and a little bit
25:35more grounded now
25:36I'm still
25:38cautious because
25:39I know that I'm not
25:40quite there yet
25:41I'm not fully qualified yet
25:42I still have to do
25:43the exit interview
25:44I still have to
25:45submit my portfolio
25:46and I just
25:47I need to keep going
25:48and I need to get
25:48through it
25:49and I need to
25:52keep going with it
26:32it's been a hectic start
26:34to student life
26:34for Rebecca
26:35we're not breathing
26:36so we just need
26:37King LT
26:38so just extra set of hands
26:39for all of an airway
26:40for us for a second
26:40stepping into an ambulance
26:42for the first time
26:43as an observer
26:44Rebecca so squeeze that
26:45bag for me
26:46one
26:47and one every six seconds
26:49she's had to learn
26:50fast on critical calls
26:52pressure still holding
26:53that 138 over 92
26:55as well as studying
26:56for her assessments
26:57in the classroom
27:09everybody dreads an OSCE
27:10and that's an objective
27:12structured clinical examination
27:14what it is basically
27:16to break it down
27:16for someone
27:17that's never seen it before
27:18it's a safe place
27:19for us
27:20to measure
27:22whether somebody's
27:22competent in the skill
27:23and that's done
27:25within the setting
27:26of the colleges
27:29in terms of prepping
27:30yourself for the exams
27:31you'd have your lectures
27:32throughout the day
27:349 to 5
27:35and then in the evening times
27:36you could be in the college
27:37up until 7, 8 o'clock
27:39in the evenings
27:39running scenarios
27:40with your classmates
27:41hi 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
27:52patient is being very difficult
27:54you're given four lives
27:56at the start
27:56if you fail
27:58your OSCE
27:59you lose a life
28:00and once you had
28:01four lives gone
28:02then you would have
28:03had to have left the programme
28:05at the Tala campus
28:06first year student
28:08Rebecca
28:08is preparing for her
28:10first ever OSCE
28:11an exam which will take place
28:13in a few weeks time
28:14right
28:14so
28:15scene safe
28:16any catastrophic hemorrhage
28:17no
28:18no
28:18okay
28:19does anybody see what's happened
28:20you're just passing down
28:21I've no first aid
28:22trying to go side in
28:23just no idea
28:23okay right
28:24hello hello
28:25can you hear me
28:25any change
28:27nope
28:28no pulse
28:28no breathing
28:29okay no pulse
28:29no breathing
28:30Phil will you grab me a BVM there
28:31and just leave it at my side
28:33the first few weeks of college
28:35were incredibly nerve-wracking
28:37you know you can't help
28:38but kind of look around the room
28:39and see who's done
28:40other pre-paramedic courses
28:43before you
28:43and kind of compare yourself
28:45and convince yourself
28:46that you're like
28:47the last one on the list
28:48behind everybody else
28:49have we got a good strong pulse
28:51yeah your pulse
28:52you're sitting at about
28:5362 weeks in a row now
28:55continue bagging him on the way
28:56into the hospital
28:56obviously
28:57anything else you'd like to do
28:59um
29:0112 lead
29:01find the source of the
29:03potential arrest
29:04I just
29:06I'm so glad
29:06I'm not in the position
29:08that Rebecca is
29:09in year one
29:10I found year one
29:11was the toughest
29:12all her OSCEs
29:13her short writings
29:14all those
29:15you know
29:16it's such a tough year
29:17but it's tough for a reason
29:19because they have to prepare you
29:20for going out
29:21I love the way I said to you outside
29:23get the BVM ready first
29:25and then put pads on
29:26and I go
29:26get the BVM ready
29:27and I'll not put pads on first
29:28so I was like
29:29I just fucking told you
29:30to give it to me first
29:31like
29:31can I have paddings okay
29:34for this scenario
29:35it's important
29:36that you just get through
29:36the exam
29:37because you can't be out
29:38on the road
29:38without passing the exam
29:44today
29:45she's back on the road
29:46with Cuiva and Greg
29:47as number three
29:48and is now expected
29:50to take on
29:50more responsibility
29:51as her training
29:52intensifies
29:54Rebecca
29:54we have a
29:5572 year old male
29:56in a GP surgery
29:57um
29:58shortens of breath
29:59high temperature
30:00most likely infection
30:01chest infection
30:02respiratory infection
30:03the doctor will generally
30:04give a comprehensive handover
30:05they'll generally tell you
30:06about the patient
30:07because most likely
30:08they know the most likely
30:09this is their local GP
30:10but it's important
30:11we still ask the patients
30:12the questions
30:12and it's not disrespectful
30:13to the doctor
30:14it's just that we have to
30:15ascertain it ourselves also
30:17I think it was the first call
30:18I'd ever been to
30:19where a GP had rang
30:21for an ambulance
30:22I was thinking about
30:23the fact that I would have to
30:24take a handover
30:25a clinical handover
30:26from the GP
30:27we had kind of said to Rebecca
30:29you take the lead on this now
30:30and you know
30:31it's a nice call
30:32you're going to get
30:33great medical history
30:34there's going to be no guessing
30:35or anything like that
30:36because it will all be very clear
30:39do you want me to
30:40attach his legs
30:41because that might catch on you
30:42no we're missing the thing
30:43oh you're missing the thing
30:44you just guide me over this bump
30:44will you
30:45you might need a hand
30:46yeah you just take the bottom of it
30:47no turn around
30:48do properly
30:49give your bags
30:49there you go
30:54and then it was a matter of
30:56into the ambulance
30:57and focusing on what the patient needed
30:59whether he needed medication
31:00to help him breathe
31:01you know
31:02did he have any chronic conditions
31:03like asthma or COPD
31:04and what we could do
31:06to help him
31:07before we got him to the hospital
31:11sorry Rebecca
31:12I'll give that to you
31:13yeah no problem
31:14just get the side of the stretcher down
31:15have the stretcher prepped
31:16yeah
31:17okay
31:17ready
31:18steady
31:19lift
31:23you alright
31:25have you been coughing much up
31:27oh
31:28on for the last month
31:29oh no
31:31it comes
31:31I mean you think you're getting better
31:33I know and it comes back again then
31:35okay
31:36I haven't got COPD
31:37I've got a check 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 okay
31:46so Rebecca so what you have to be mindful Rebecca of your position
31:49so you should be down this end
31:50to help Quiver transfer over
31:52no you sit down there
31:52okay
31:53so you have to be mindful of that
31:54okay
31:54that's what I'm talking about prep work
31:55so we're going to work on that today
31:56yeah
31:59there's a bit of a jump between the 7 week
32:00and the 15 week placement
32:03so you're feeling that bit more qualified
32:07which is quickly wiped out
32:09as soon as you get out onto the road again
32:10you know you're kind of brought back into reality
32:13I'm going to take that off for a second
32:14we'll do seatbelts before we do monitor
32:16because with these seatbelts
32:18it gets cost
32:19yeah no problem
32:20you get all tangled
32:21so you're better off having them on
32:22and that was the learning from the last call
32:24okay
32:25seatbelts before monitor
32:26Quiver set you
32:27so we have to keep that in mind okay
32:28yeah
32:28so each call is a learning call
32:30each call is a development call
32:31and there are milestones
32:32you have to meet each call
32:33okay
32:34with the new structures that we have
32:36we always say you know
32:37put the seatbelts on first
32:38and the monitor on afterwards
32:39because that way then
32:41it doesn't all get tangled up in between
32:43and so there's a few little things like that
32:44that was just
32:45would make her day easier
32:47and would make her calls easier
32:48and would make it more comfortable for the patient
32:51it all just seems like
32:52run-of-the-mill stuff
32:54but if it's not done
32:55then you'll just run into 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
33:04okay right
33:05I'm just gonna take your temperature
33:06you keep going
33:07work around me
33:08yeah
33:08do it at the same time
33:09yeah
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
33:20yeah this one's not on
33:23gets caught in the clothes sometimes
33:24that's all
33:26everybody I've worked with
33:27they've all been able to teach me a lot
33:28I 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
33:41he's been coughing for about a month
33:43and he was hypertensive
33:45today
33:45yeah today
33:46now he's 38 in the ambulance with us
33:48but he was 38.8 in the GP's office
33:50he has mild pitting edema in his legs
33:52and that's new
33:53well I asked him
33:54had 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
34:04Greg leads a post-call debrief
34:08patient is paramount
34:09patient is priority
34:09and saying yeah is okay
34:12doing it on the next call is concrete
34:15that's the difference okay
34:16because we can all say yeah another head
34:18but if I don't know it's not going in
34:20it means departing knowledge that we're giving to you
34:22to nurture you
34:23to develop you
34:24into the paramedic of the future
34:25is not happening
34:26next call
34:27we'll build on what we learned in this call
34:29patient assessment wise
34:30you didn't really do one
34:32okay
34:32yeah you got a good clinical handover from the doctor
34:35we've done everything else
34:36she 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
34:47there was criticism from Greg
34:49which is expected
34:50you know you're on your seven weeks
34:51I expect it to be criticised after every call
34:53because if you can't
34:56then there's zero point in you being out on placement
34:59do the assessment
35:00do the clinical diagnosis
35:02then give the clinical handover
35:03so part A excellent
35:05part C excellent
35:06let's work on part B
35:23are you going on holidays anywhere are you?
35:26yeah
35:26well I went to Tenerife in January with the Lasby College
35:30and I went to Belfast Dublin
35:32and Marseille in there two weeks ago
35:35so the three places
35:38yeah so that was a bit of crap
35:43in Castle Bar
35:44second year student Ryan
35:46is on shift with advanced paramedic Tommy
35:50Tommy's a gentleman
35:51obviously as an AP
35:52he brings a more broader spectrum of skills to the table
35:57and in fairness to him
35:58he'll tell you how it is
35:59if you've done something wrong
36:01he'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
36:06you'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 place where the
36:17eight roads come into the morning
36:18oh is it
36:19is that in cars?
36:21yeah
36:21at work we clock up a fair few miles
36:25and 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
36:37it's a very vast area
36:39so we could get a call in Achill
36:41and our very next call could be in Balahadrine
36:44so it's a massive area
36:46but the majority of our calls
36:48and a lot of our calls
36:49seem to be elderly patients
36:51today the lads are responding to a call
36:53where an elderly lady has fallen at home
36:56hey how's it going?
36:58how's it keeping?
36:58what's her name?
36:59Tony
36:59are 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
37:12who lives alone
37:13hasn't been able to move since falling
37:15a 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
37:21oh
37:22I wouldn't be a good footballer
37:24oh god love you
37:25or dancer
37:27well I wouldn't be far behind you Irene
37:29I'm not greater than myself
37:30two left feet he has
37:31I'd be a good talker anyways
37:33so I would
37:35I'd talk the donkey off the horse's back
37:37I would so
37:39yeah
37:40you're swimming against the tide straight away
37:42if 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
37:55I don't be telling him that
37:56don't be flattering me now
37:58I'm flustered here now is enough so I am
38:02yeah certainly flirtatious commentary
38:05but look at life's too short
38:08you have to have a laugh sometimes
38:09will 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
38:17you had a hip replacement?
38:20yeah
38:20which one?
38:21the left one
38:22okay
38:22we did initial assessments on her
38:25just to rule out any serious injury from the fall
38:29and just kind of gathered a patient history as well
38:32in terms of the events leading up to the fall as well
38:34so after assessing her then
38:36and doing the few bits with her blood pressure
38:38and that kind of thing
38:39we were happy enough to sit her up
38:41and get her up off the floor
38:43what we'll do is
38:44try and bend up your two legs if you can
38:46we'll sit you up a bit
38:47and then try and bend up the knees if you can
38:48you ready?
38:49yeah
38:49one, two, three
38:51oh god bless you
38:54yes
38:55she had a minor wound on the bridge of her nose as well
38:58so she's obviously suffered some minor trauma there
39:02on 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
39:14you know there's less risk of them happening again
39:16we'll throw the legs up by Irene
39:18if 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
39:49I was a nurse
39:50a nurse
39:51I worked in Mayo General
39:53oh right
39:54I don't think anyone there
39:56I don't know anyone there now
39:58because it's a good many years since I left
40:00and were you long in the nursing field then were you?
40:04oh god
40:04I went to England at 17
40:07and I started my nursing there
40:09yeah
40:10I worked there for sort of two years
40:12and 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 has now been returned to her in her time of need as well
40:27just at the moment anyways
40:28Irene all your vitals are perfect
40:30your heart rate
40:31your oxygen levels
40:32your blood pressure
40:32there's nothing on earth there at the moment
40:35so there is a very healthy thank god
40:37like my age
40:39I tell you you had me fooled
40:40I thought you were in your 70s
40:41oh thank you
40:46how was that?
40:47you can slow down a little
40:49oh well
40:50thank you very much
40:53ease up on the right foot
40:55well this is it Irene
40:57can I give these bits to you
40:59your tablets there
41:01is that alright?
41:02this blanket up around you
41:03do you want to pop the two arms in
41:04and we'll keep you nice and warm
41:05oh that's lovely
41:07god bless
41:07now
41:18a few bumps coming out here I mean
41:19a few bumps
41:22so Ryan performed quite well in 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
41:36go and 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 with a classmate
41:57go through sample
41:59go through the seven weeks
42:01and then reassess everything
42:03yeah just reassess ABC
42:04and then go to the hospital
42:06for long-term pain relief
42:08I'm considering ibuprofen and her seat was
42:10yeah
42:11yeah
42:11perfect
42:12yeah perfect
42:13we have our OSCEs which are the practical exams
42:16everybody is kind of
42:18different mixed emotions
42:20you know some people are really nervous
42:21some people are completely comfortable
42:23and confident
42:24I'm kind of a unique case
42:26because I have a real fake it till you make
42:28kind of approach to it
42:29so you have to convince yourself
42:32you're not nervous at all
42:33if you get after a case
42:34and it's positive
42:36remember to ask
42:36do you still have your appendix
42:38okay
42:38and bowel movements
42:39and bowel movements
42:40how's your bowel movement been
42:42oh yeah
42:42I didn't even do that
42:44we all have the same end goal of passing at the end of the day
42:47so
42:47I think it's really important
42:49like nobody wants anybody to be left behind
42:51so
42:52we're all kind of doing a group effort
42:54to get everyone over the finish line
42:56anything you don't want
42:57leave it in there guys
42:58I'm done with you
43:00so I think it's really important
43:02you know
43:02during exams
43:04to remind yourself
43:05of all the training you've done
43:06and kind of fall back on that
43:08you know
43:09if you've done the prep for it
43:11then you should be fine
43:21start assessment
43:51next time
43:56we better go
43:58it's cardiac
44:02where's that catch?
44:04this side
44:05over here?
44:06yeah
44:06that's alright
44:07we'll do all the work
44:14breathing new life
44:16into dated spaces
44:17and all on a budget
44:18catch the complete series
44:20of the salvage squad
44:21streaming right now
44:22on virgin media play
44:46if you've been affected by any of the issues raised in this program
44:49please visit our support page
44:51virginmediatelevision.ie
44:53forward slash helplines
44:55I'll see you next time
44:55I'll see you next time
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