Richard is an Emergency Care Practitioner working in a small remote town of less than 500 people. The clinic from which he operates is located in the middle of the desert. This hampers attempts to respond to emergencies in a timely manner. Richard commends his community for being sensitive to local challenges, and for being responsible enough to desist from engaging in any behaviour— such as taking intoxicating substances—that may result in call-outs for paramedic services. Like most of his peers working in remote areas, Richard’s commitment to positive health outcomes for the community he serves is demonstrated through early morning starts, late working hours, and the generally long days.

Richard’s story: 

It’s cold tonight. Normally I’m tucked up in bed at this time but duty calls. 2350 hrs and I have an emergency call to care for a crush injury to a hand— a common presentation in the mining sector. Normal paramedic primary/secondary survey kicks in and is over in a few minutes. Now onto the closer inspection and examination of the injured hand. It’s a particularly nasty digit injury and there is indication of deep structure damage. A local anaesthetic allows for closer and deeper examination, which reveals a digital nerve has been damaged and there is a 75% transection of an extensor tendon. Prophylactic tetanus booster, dress the injury, analgesia for the wait until morning. Now to arrange medivac out and referral to a specialty hand clinic for further assessment and likely surgery. Print the referral, complete patient notes, update injury management teams and managers, then back to bed. It’s now 0200 hrs—I have to be up at 0430 hrs…

Well, up again, shower, breakfast and off to one of our two clinics for morning random drug and alcohol testing. I carry out telephone follow-up on a couple of patients from earlier in the swing, and field some calls from new patients and often concerned supervisory staff. Telephone triage reveals two patients will need a home visit as they have a few symptoms I’m not
happy about.

Randoms all come back clear—which is the norm at this site. After all, we are a small site—less than 500 souls—in the middle of the desert with no general hospital close by. It’s four hours by road to our nearest full ED/surgical suite. People tend to be fairly switched on to their vulnerability and this is reflected in their professional approach to avoiding intoxicating substances in
our environment.

I follow up on the patient from last night and am relieved to find he is already in the air on his way back to his home port, and definitive care, via a commercial flight. His injury manager has emailed to confirm his appointments and will forward all supporting paperwork for filing as and when it is available.
Now for the home visits. Jump in the ‘ambo’ (ambulance) and head off to camp—a five-minute drive from this morning’s clinic. The first patient has diarrhoea—a very common complaint which spreads rapidly where we have people in close contact and communal facilities. He is over 60 years old, has several comorbidities and is a polypharmacy nightmare. Observations suggest he is compensating well at this time so, in discussion, we arrive at a ‘watch, wait and see’ approach for the next six hours, with a follow-up later that day and reassessment as necessary.

Next is a female patient with palpitations and feeling ‘unable to cope.’ History reveals a longstanding mental health issue which has, until recently, been well controlled. The negative symptoms have returned since cessation of her medication without medical advice. She is due out this afternoon in any case, as her swing is over. I ensure she is safe and understands that she will have welfare checks hourly until I return later. Back at the clinic, I write her a referral to take back to her GP. I take it back to her room where she is chatting happily with her supervisor. The supervisor informs me she will stay until it is time to fly out—which is great news.
Follow up on D&V patient—all well. 

More notes, admin, and general tidy-up. Stock order as we are running low on standard medications.

Day is done and off to dinner at 1700 hrs. Quick workout, shower, then off to bed. Ahh, warm, cosy, zzzzzz.