My Ambulance Placement

This post is dedicated to my ambulance placement at Satakunta pelastuslaitos in Pori which I loved very much. It was an amazing opportunity to work with paramedics in Finland, in fact , nurses can actually work as paramedics straight after they graduate from nursing school, they will only need extra short course to obtain whilst working in ambulance. However in the UK you have to obtain a paramedics degree in order to work as paramedic. 

In this placement I managed to get an overall perspective into the working environment in the ambulance station in Finland and recognize the similarities and differences between Finland and United Kingdom practices.  I have familiarized myself with the environment in the ambulance station in Pori- Finland and the various roles within the ambulance station (Ambulance staff, fire men) and knowing how many ambulance cars in the station (Three one for transfer and two for emergencies) in addition to one in Meri-pori and one in Ulvila ( small towns near Pori). The one in Meri-pori joins the Pori ambulance station after 10 pm.  I have learned about the working pattern. The working shift for ambulance staff is 24 hours followed by three days off. The team is divided into four groups that work alternately every three days (24 hours). Each group has a manager. Each car has two members of staff- one nurse and one fireman or sometimes two nurses. Ambulance transfer car has a practical nurse and not a nurse.

       

Despite the fact that I was not be able to perform the documentation in the ambulance car due to the language barrier, yet I was interested to have knowledge on what is involved in the documentation process and interviewing the patients. I have tried to learn many Finnish phrases and works that are commonly used in the interview, which has helped me greatly in understanding the patient condition and the reason for the call.

I have learned about many aspects of the documents and what is required to complete inside the incident reporting form, similar to timing (documenting when the call is made, when the team receives the job, when the team arrives at the site of incident, when we meet the patient, when we transfer the patient, when we hand the patient to the hospital and when the job is completed). I have learnt about the importance of timing and recording the times in case of investigation. I have learned also about the importance of recording any past medical history, the description of the patient condition at arrival and the care that is provided to the patient. Important part of the documentation is recording any drug allergies. These are the important aspects of the documentation; this is in addition to other aspects similar the position of patient during the transfer.

I learned about the multidisciplinary team working in the ambulance, working along side with firemen and liaising with the police in case there is a need.

I have observed and learned great deal about many care pathways for many emergency cases. How to use the ABCD approach (Airway, Breathing, Circulation and Disability) How to preform general initial assessment, using LP machine and taking vital signs similar to blood pressure, pulse, oxygen saturation, blood sugar level and assess patients’ pain level.  I have come across trauma cases similar to bleeding and fractures as a result of falls or car accidents, I have learned how to initially care for these patients and what medication to be given to provide quick and effective pain relief. I have come across patients with breathing difficulties or chest pain and learned how to interpret the vital signs of the critically ill patient; suspicion of stroke and how to neurologically assess the patient and use (GCS) Glasgow Coma Scale, I have also come across patients with convulsions and knowing the initial pre-hospital care for them.  I have practised and learned many new skills, similar to creating IV access and prepare and administer IV fluids, administer emergency medication intravenous and intramuscular, similar to pain killers (Oxynest), antiemetic drugs and cardiac medications. This is in addition to oxygen delivery and learning about different types of dressings for wounds. I have learned about the medication kept in the ambulance car and method of their action and what side effects they can cause.

I had a great insight into mental health first aid, dealing with alcoholics with aggressive behaviour knowing how to use the Alco-meter, liaising with police in case they are needed. I have observed dealing with individuals with serious suicide thoughts, and how to approach to them.

I have learned how to use the equipment in the ambulance car and to know what is kept inside the car. There are many bags in the car each is designated for various tasks, similar to dressings and supplies bag, intubation and CBAP bag, birth delivery bag, Life pack machines that measures vital signs and analyse EKG’s.  There is a bag equipped with all the cannulas, lines and infusion sets, replantation bags, a bag for children emergencies. I have learned also about the different fluids and infusion in the car and when to use them (The most commonly used fluid is Ringer). This is in addition to various equipment for transporting or immobilizing patients and supporting them if they have fractures similar to vacuum mattresses, spinal board, cervical collars and splints.

I have also assisted in the morning checks for the ambulance care, checking all the supplies in the car that they are sufficient and adequate, checking the LP machine and replace the batteries. I have learnt also about manual and handling the ambulance car bed and safe transporting patients.

Finally, my interest in learning the Finnish language and communicating with patients in Finnish, introducing myself in Finnish and telling them what I’m doing during procedures, comforting and offering them help.

Medication used in the car

Replantation Bag