Day in the life of an advanced life-support paramedic in KZN

Introduction 

The South African road death toll is a major concern for road safety authorities. The ‘fatal road deaths stats’, however, only tell a small part of the story. Had it not been for highly qualified and hard working first responders managing to save lives, this would have been far worse.

In South Africa we find highly dedicated paramedics working for both the State and private medical services, responding to road crash and crime scenes day and night.

Most of us know little about the work these paramedics do. We hear the sirens, see the ambulances and drive past the crash scenes without an understanding of what happens prior to and post a call-out.

Robert McKenzie, an advanced life-support paramedics in KZN has offered to share with us his account of a recent day’s working operations from Port Shepstone on the South Coast of KZN. Here is his interesting account.

Early morning

"My morning would start like any other person’s morning, I presume - except there are messages on my phone, about motor vehicle collisions and incidents that happened the night before and probably me loving coffee more than most?! While driving to work, I am already starting to prepare myself mentally for the day ahead, which is quite hard, as you don’t know what’s going to happen during the day. The day shift is from 07h00 to 19h00 and I’m standing in on a shift that doesn’t have an Advanced Life Support paramedic.

When I arrive at base, I’m met by some of the off-going paramedics who had worked the night shift. They are over-tired and in a light-hearted mood, glad that their shift is over. I asked how the night was and “it was crazy man” was the short and blunt answer I got. I should have known it was busy - it is an end-of-month weekend and some of the crews had travelled several hundred kilometres during the night.

I met the night shift paramedic in the Advanced Life Support paramedics’ office, which is more of a mini store-room than a traditional office, with medical stock and different kinds of  medical equipment and monitors kept there. She had just returned from an ICU transfer, where a patient is moved between two hospitals. A brief, “you just have to change the oxygen and I’ll see you tonight” was the very brief but conclusive hand-over as she walked out of the base directly to her car, deliberately not stopping to talk to anyone, as it would delay her getting home and into bed.

A quick staff parade is done before checking the response vehicle. You have to check not only the vehicle for defects and damages etc., but also all the medical stock and equipment; you need to check that the equipment works and is charged and that there are enough medical sundries. As a rough guide we try to keep enough stock on the response vehicle, between our jump bags and the spare stock on the spare bags, to be able to start basic treatment for a mini-bus load of patients (which is normally 16).

Staff cleaning the ambulance before going on a case.

After checking the response vehicle I make a turn at the Emergency Call Management Centre, where the emergency calls are received. Some of the day shift paramedics have already taken details for cases; there are still cases where an ambulance needs to be sent. I help the dispatcher reprioritize the cases, which are mostly assault cases. While in the centre, a call comes in: there has been a house fire and the police and fire department, who are on scene, suspect that an elderly lady has died. An ambulance crew and I are dispatched to the case.

On the way to the case I’m reminded of the diversity of the people we encounter. What reminded  me of this is on the main road on the way to  the case, some people were just milling abound, others standing around a car parked on the side of the road, listening to music, while others, dressed in their church clothes, were waiting for their lift next to the road. Due to it still being early and cool, there were also a few runners exercising, ranging from fit looking athletes to a small group of teens in their karate clothes.

Just after turning off the main road and starting to look for the scene I was turned away from the case because the ambulance had already reached the scene and sadly the lady had already passed away. An unattended candle left burning during the night being the suspected cause of the fire.

I was immediately dispatched to another case, this time a medical case about half an hour away. On the way I was listening to the two-way radio as the other ambulances were arriving on scenes that they had been dispatched to, but where there were no patients to attend to.

When I got closer to the area, I had to get directions to the scene from the ambulance crews who are more familiar with the area. Navigating in the rural areas is not the same as the urban areas - very few roads have names and if they are named  they are not marked, there are no street numbers, while some of the houses have a five-digit number painted on the side. There doesn’t seem to be any logical numerical relationship between the numbers.

Directions are normally in the form of landmarks, like community halls, bridges, schools and little spaza shops.

A picture of the surroundings where is stopped to get directions to scene.

I know which turn-off from the main road I need to take and then I am told I need to pass two schools on my left and the scene will be before the blue tuck shop. Not long after turning off the main road the road turns to gravel and I’m reminded why our response vehicles are 4x4 bakkies and not the sports cars that some paramedics in the cities have. After driving for some time I suspect I may have gone too far and I ask for directions from a mini-bus driver who doesn’t know the name of the shop I’m looking for but assures me that I have proceeded too far.

The mini bus driver was inadvertently right; the emergency call management centre had been in contact with the family of the patient, who said they saw me drive past. So I turned around and proceeded back in the direction I had come from. This time I managed to see the sign board ‘lucky shop’, which was in fact a red shipping container and not a building as I had been expecting.

The ambulance arrived on the scene shortly afterwards and we treated the elderly patient for the medical condition which she was presenting for the first time. One thing many paramedics forget is that during emergencies you have to treat the patient and the family. The patient is treated for whichever condition or injury they have, and the family who are normally very concerned about their relative need to be reassured and informed as to what has been done for the patient.

We then transported the patient to hospital in a serious but stable condition. At the hospital the doctors and nurses were still busy treating the over influx of trauma patients from the previous night.

A panoramic picture of the scene where we picked up the patient, with 'lucky store' on the right

We handed the patient over to the doctor. The ambulance was given further details and I started to proceed back in the direction of the base. On the way back to the base I came across the fire department and a tow-truck parked on the side of the road. I thought there may have been a collision that they were attending to, but it was for a car that had caught alight.

The fire department had already extinguished the fire and the driver had managed to escape without any injuries, but the car was severely burnt and beyond repair.

The car that burnt out

When I got back to base there was no time to put my feet up and relax; I had plenty of admin work to complete - a laborious but vitally important task, especially in the medical field. As fate would have it I was saved from too much admin work. I was dispatched to a bottle store where two men had been fighting and had assaulted each other. To my relief, when approaching the scene I could see that the police were already on-scene. Two men had an argument  (apparently about the one owing the other six Rands) and the one was hit on the head with a bottle. The other man had been taken away from the scene by his friends.

I bandaged the man’s wounds and checked his vital signs. He was stable, but due to being under the influence, he didn’t realize the severity of his wounds and tried his best to convince the policeman to give him a lift to his house. He eventually realized that he needed to go to hospital for stitches and when the ambulance arrived he was transported to hospital, where he was later discharged after being sutured.

Mid-afternoon

Mid-afternoon, there were no cases outstanding and some of the ambulances were dispatched to transfer stable patients back to the hospitals they had been transferred from, while other ambulances were available from the base.

Early that evening I was dispatched to a motor vehicle collision about 40 minutes away from the base. The shift supervisor and I responded to the collision. There are road-works on the section of road that we had to use and we battled to get past the vehicles. Eventually we managed to get past the road-works section and all the vehicles, and we made it on to the open road.

While driving I noticed a truck on the side of the road with its hazard lights on, and a few people standing behind the truck, with others still running closer. They were standing around a man lying motionless on the side of the road. I realized that he had been hit by the truck. The accident had only just happened. The station officer continued on to the original crash scene and I stopped to assist the man. I parked my response vehicle between the oncoming traffic and the injured man. As it was on a bend in the road and almost dark, I was worried that ongoing vehicles were going to hit us while we were standing on the side of the road. Using the two-way radio, I asked the control centre to send the police and an ambulance to come and assist me.

I carry my equipment to the man’s side while some of the by-standers are already crying because they think that the man is dead. I asses the man’s condition: he is critically injured but still alive. I’m still the only person from the emergency services on scene but I start treating the man, giving him oxygen, putting up drips and connecting the relevant monitors to check and monitor his vital signs. A police van arrives from the nearby station and the one policeman puts on gloves and helps me while the other policeman assists with traffic flow past the scene.

When the ambulance arrived, the ambulance crews assisted me to treat the patient. We administered the required medical care to the man and loaded him into the ambulance. By this time it was dark and had started to rain and we were glad to be off the side of the road as cars were driving fast round the corner and past the scene, despite early warnings by the Police and RTI.

Transporting the patient

The trip to the hospital seemed to take forever as we had to pass though the same section of road-works to get to hospital. The hospital staff had been updated regarding the patient and there was a trauma team waiting for us, and when we got to hospital I handed the patient over to them. During the hand-over to the doctors, you tell them what is wrong with the patient, what the injuries are and what your treatment has been. You then also complete a written hand-over document, which the doctor signs and which goes into the patient’s file.

It was already well after 19h00 and when we got back to base. Some of the night-shift crews who were now rested andfull of energy and jokes, ready to start their last night shift before going off on their rest days.

While driving home, I was thinking about the case I had just done: is there anything I could have done differently or better and if he will be okay - thoughts which ended quickly when I got home, as my tired son screamed “daddy’s home”. My baby was safely asleep and my other son needed to be carried to bed after falling asleep on the couch, not managing to stay awake to see dad.

My working day was over for now; I was at home - or now at least - something which I cherish, because a paramedic is never really off duty. There is always a phone that can ring, with the person saying “there is a child”, “there’s a bus overturned”, “multiple critical patients, we need you”, “there is a…..” - before you can even say “hello”.

Conclusion

We would like to extend a word of appreciation to Robert and all the other emergency servicess personnel attending to the scenes of road crashes daily! The above information provides important insights to some of the challenges experienced by the emergency services. May we as everyday road users seek to make their task easier by allowing them a safe passage to reach road crash and other victims! 

Biography

Robert Mckenzie Married to Charline and have three children, two boys and a beautiful little girl, Mia I work for KZN Emergency Medical Services, the former EMRS in KZN. Where I started as a shift paramedic, I’m now doing clinical coordination for the Ugu health district for EMS. I’m on several committees at a district and provincial level for EMS and Department of Health. I’m doing the media work of EMS currently and I still see clients in the pre hospital environment as an Advanced Life Support Paramedic. I left straight from school to study Emergency Medical Care at the former Durban Institute of Technology where a qualified with my N.Dip in EMC in 2004 and my BTech in EMC from the Durban University of Technology, in 2006.

Also View:

How do I become a Paramedic? 

Different levels of Emergency Personnel 

Emergency response time and responding to road crashes