Day 4 - emergency day

Hey travel journal,
Today was the paramedics day to fan girl with an emergency focus.
After waking up way to early (only got 5hrs sleep) we went to our regular breakfast spot and got rice rolls today. It's rice, then pickled vegetables and pork floss, a fried bread all rolled up like sushi. It was filling but super tasty. Then we headed back to the shin Kong Wu hi-su memorial hospital and met an ER doctor who took us to the local fire station. This fire station has a massive emt base and do emt training. We had a tour and a number of presentations which were so awesome that I took notes the whole time. All of the fire stations are either one or two tear. Of the 48 fire stations in Taipei, four of them are two tear with fully trained emt2, (their version of a paramedic). Across all of these stations they have 83 EMTs, and 614 EMT2s, which is a total of 699. They are dispatched to 130,000 jobs per year (2017). They followProtocol driven and by online medical demand programs and have a set scope of practice which includes advanced airway, CPR and 6 drugs. All of their training is on the ground like an intern ship. They have strict protocols with a lot of their drugs, for example with midazalam they are only allowed to give it if the seizure lasts for more then 10mins or its their second seizure. They Introduced bystander CPR (eg 000 guided) has improved prehospital MI outcomes. The introduction of major trauma centres and major trauma criteria to bypass is also reducing the rates of mortality following road traffic accidents. Prehospital ecg can be completed on scene using a portable ecg machine that takes the images and sends it directly to doc at hospital who interprets it. They have an awesome mass causality truck that sets up to have 6 beds the pull out with suction and oxygen, so you can have treating beds at the side of the accident. During a mass casualty event they send the ambulances but they also send doctors and nurses from the hospital. The mass casualties patient ID cards all have barcodes to record patients. I'd tags, are plastic so they don't tear and barcodes are stickers that you peel off and stick on the slap band on the patient. Only four of the 8 hospitals are major trauma functioning 24 although all hospitals are well equipped. The average is a 6 minute response time in taipai. Transport time averages 7 minutes. 12 lead rarely done because of this and it's still a pilot study (just introducing). Taipei is a basin surrounded by mountains. Stations in the mountains have longer response and transport so maybe ecg more helpful. All ambos have mechanical CPR device to increase safety for ambo during transport and because most people live in apartments with no elevator. Transport of CPR patients occurs after two cycles regardless of outcome or patient status. Introduced last yr. Multi trauma tags are slap wrist bands. Trauma ID pack has bands, OPAs and tags with barcords. Barcodes uploaded to database to keep track of total scene in real time. It was so. Cool they let us get into the back of an ambulance and mass casualty truck and go through all the kits. They have some stuff like the ancient stretchers and individual equipment for each monitoring equipment that seems like they are so behind, but they also have some things that are so much better, like the laryngoscopes all have cameras attached which are so cool. They also have a tablet and dispatch protocol that is similar to ours.
They have cameras constantly recording in the back of their ambulances. They showed us a video and went through a case study from last year.
Case:
Dec 9th last year. chest pain 41yof 20mins on scene and 20min transport. Sitting on sofa, no radiation, central chest pain, 5mins duration. no hx, BP 90/72 99% gcs 15. Opqrst 5mins, duration persistant, 8/10 pain, no relief or make worse, no radiation. 12 lead = in ambo - vf, loss of consciousness, CPR started 2 mins, defibrillator, lma placement, CPR 2 mins Rosc on scene. Vss became stable. Video on ambulance. Still doing 30;2 even with Lma. Will be changing protocol this year. Still ventilated with bvm even after patient was moving during transport until completely conscious then removed and an o2 mask was put on. Ecg transmitted to doc in real time. Discharged from hospital in 5 days. Emt gets feedback from doc on case and patient outcome. Pacemaker $3000 US, government funded after two VF attacks. No found underlying cause of VF.
While we were there they got a real call come through the station which was signified by a phone ringing and bell sounding.
At the end of the presentation they gave us all gift bags which are amazing. They have a fire alarm shaped timer, note book, towel, a money box shaped like a gas bottle and whistle.
Then we walked over to a health building and checked out the ophthalmology centre which only opened 3 days ago. It's an out patient centre where do they do eye exams and surgery. Then we headed down stairs and walked through the rehabilitation centre, which was pretty much a massive room with lots of equipment and lots of people working one on one with a physiotherapist.
Then we headed out for lunch and I ended up with the same thing as yesterday and my first real bubble tea. Which was ok. The bubbles are weird but not too bad. And we had two hours to just chill where people played on their phone, studied, completed job applications and played cards. It was nice to have the first kind of down time we have had since getting here.
In the afternoon we had an introduction and tour of the ER. They have a 5 tear triage system. Level 1 is life threatening eg resuscitation, 2= critical, rapid deterioration, 3= urgent, likelyhood for rapid deterioration, 4= less urgent, chronic conditions not life threatening, 5 = super stable. They have four observation rooms, a resuscitation room, isolation room (which is used mostly for domestic vilence victims) and a couple of speciality rooms (eg. Surgical, PeP room). Common complaints include chest pain, a do pain, sob, dysuria etc. Ecg's are given to patients only over 50yrs, acute pain, epigastrix or pain over 10mins. Their pre-phoning and trauma teams are very similar to ours. Their primary pain relief is morphine as they feel that fentanyl doesn't work as well for pain management in patients. From ER they then move through the hospital system or move to discharge. The national health insurance is compulsory for all citizens from birth meaning they have low copayments. Then we had a tour of the emergency department which is not as big as I expected but has a hell of a lot of people. They hall ways are all lined with people on beds where they can apparently stay for up to three days. And some patients can wait for hours to be seen the same as at home. We split into three groups and spent some time in each of the sections talking to staff. Their triage is pretty much the same as ours. Except the general public and ambos use the same triage nurse and because ambo patients are always emergent there is no such thing as ramping. They have a waiting room and then one at a time they see a nurse who gets some details and does a vitals check and decides where they go. Then they have to go to a Window and fill in more paper work and pay a fee before they head into the ER. There they wait again and then get seen by a doctor in one of the many rooms. They have a number of observation rooms, an ecocardiograph, radiography, a surgery prep room (where they do minor procedures like sutures etc) and medicine where they do ecg's and take bloods for example they had a cardiac, chest pain patient in the medicine room and rtc patient with minor lacerations being cleaned up in surgery after being cleared by xray. It was very interesting and super busy. After that we took a vote and headed back to the dorm to have a lazy night in. I decided to be a little antisocial and did some washing, cleaned up the burst blister on my foot, check emails, watch TV, you know all that boring chilling stuff. Then we all got together and headed out for dinner. We found a little vendor were we picked our own ingredients and they made us a hot pot. I had baby corn, cabbage, broccoli, tofu, and rice noodles. It was pretty tasty. We all took our food back to the dorm and sat on the floor in one of the dorms and just ate and chatted. Then I took the rubbish down to the garbage car (there are no bins on campus a guy comes and gets it and takes it to the tip). And then it was time to shower and bed. Awesome emergency day :) night xRead more