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– If a patient trying to register with his GP because of nagging pain hears that he is due in two days, he calls the emergency room in desperation. Last year, there were over 6 million phone calls. The ambulance left 3 million times. This means that half of the callers either wanted to get only advice or unnecessarily call an ambulance – says Klaudiusz Nadolny, paramedic, coordinator of the ambulance service in the Silesian Voivodeship. We remind you of the interview that appeared in our pages on March 27, 2018.
- The number of calls to the ambulance service is growing year by year, but this is mainly due to the difficulties in accessing doctors in clinics.
- – Human fantasy knows no bounds. An interesting film could be made from the things that are stuck in the female genitalia – says Klaudiusz Nadolny, paramedic
- It often happens that the dispatcher sends an ambulance to a sick person who does not need it at all. This is because a lot of people know how to cheat him
Halina Pilonis, MedTvoiLokony: You are called to very different incidents. Can rescuers be surprised by anything else at work?
Klaudiusz Nadolny, paramedic: Each trip is unknown. Sometimes the accidents that happen to people are really surprising. It also happens that someone calls an ambulance to a loved one because she is unconscious and is not breathing, and after arriving at the place it turns out that it was a dog. Sometimes we go to one patient, and it turns out that there are more of them.
I remember a case where my wife called an ambulance because my husband had a heart attack. When we got there, she too had a heart attack. So instead of one patient, we had two. There are also “funny” situations. It happens that when the dispatcher orders the accompanying person to perform heart massage of the injured person until the arrival of the ambulance, which consists in even compressing the chest, the rescuers, after reaching the place, see that the callers misunderstood the instructions. He only heard the word massage and with gentle circular movements he strokes the victim near the sternum.
In the movie “Botox”, Patryk Vega posted a scene in which an ambulance was called to an injured person who had sex with a dog and a small problem appeared. Do such situations happen?
Yes. Human fantasy knows no bounds. An interesting movie could be made of the things that were stuck in the female genitalia. Bleeding and organ damage often result in unsuccessful attempts by the injured to remove them. We also had a case that the seventy-year-old was unable to pull out the vibrator he had inserted himself into his anus. However, I would like to emphasize that for rescuers these are not some extraordinary situations. We follow the procedures and when a foreign body gets stuck somewhere, we know what to do.
Are there many unnecessary challenges?
The number of calls to the ambulance service is growing year by year, but this is mainly due to the difficulties in accessing doctors in clinics. Last year, there were over 6 million phones. In contrast, the ambulance left 3 million times. This means that half of the callers either wanted advice or wanted an ambulance unnecessarily. This is the result of malfunctioning primary health care as well as night and holiday aid.
If we have a sudden cold with a high fever at night, can we call an ambulance?
This is not a medical emergency. Besides, it does not make sense, because a doctor, paramedic from the medical rescue team cannot prescribe a prescription for a sick person. There are also no cold remedies or prescriptions in the ambulance. Better then, take antipyretics and either go to nighttime medical help or go to your primary care physician in the morning.
Does every pain warrant an ambulance?
Pain is a relative term. The dispatcher tries to assess through appropriate questions whether it requires emergency medical services. If the patient has experienced severe abdominal pain for 10 minutes, he will definitely send an ambulance, but if he reports that his knee has been sore for a week, he will advise him to go to an orthopedist.
And if someone has known for a long time that they have kidney stones but gets renal colic, why not call an ambulance?
Of course. Pain in renal colic is one of the strongest. In such situations, an emergency medical team should be dispatched.
When you go to a sick person, do you have any medications with you to relieve any type of pain?
Paramedics now have a choice of six painkillers in ambulances. It is important to adjust the correct measure to the intensity of the pain. Paracetamol will not help with inflammatory and visceral pain, and the dose of ketoprofen given will not relieve it in a hip or pelvic fracture. Therefore, rescuers also have very effective opioid drugs at their disposal.
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However, there is a saying that there is no pain in the patient that the paramedic would not be able to bear, and research shows that only 16 percent. accident victims are given anesthetics in the ambulance. Why?
Sometimes rescuers fear the effects of painkillers and therefore do not use them. And this is due to the lack of adequate education. Therefore, it is important to post-graduate training in this field of all professional groups, not only paramedics. In addition, there are old prejudices that administering drugs in an ambulance may mask the true picture of the disease. Meanwhile, the use of ultrasound, computed tomography or magnetic resonance imaging in diagnostics allows for diagnosis even in an anesthetized patient. We also lack intranasal and inhalation painkillers already available in other countries. Puncture of the vein is often difficult, for example when the patient is trapped in a car or the rescue operation is conducted in difficult weather conditions. And the inhalation drug is much easier to administer. It works after just a few minutes. Its application resembles smoking an electronic cigarette. The patient can dose himself a dose depending on the intensity of the pain. These types of drugs have been used for 30-40 years in other countries of the world.
Can paramedics be checked to see if they have used adequate painkillers?
Yes. Every action of the rescue team, procedures performed and drugs used are monitored. Each trip produces an electronic report that enables monitoring of the entire emergency medical system at every level.
Can the caller be punished for an unjustified ambulance call? How?
The medical dispatcher decides whether the ambulance will arrive. If the summoner misleads him and the ambulance arrives despite the lack of urgent need, he may be punished. Article 66, para. 1 of the Code of Petty Offenses specifies that anyone who wants to cause an unnecessary action with false information or otherwise misleads a public utility institution or a security, public order or health protection authority, shall be liable to arrest, restriction of liberty or a fine up to PLN 1500. Refers to situations where misrepresentation is made.
So when should you call 999 or 112?
Only in emergencies. This may be due to sudden severe pain, severe shortness of breath or other serious symptoms. However, if we have been in pain for a few days, or if we have a cough or a fever, we should go to our family doctor.
Well, sometimes we’re not sure if it’s an emergency, so it’s better to be safe than sorry.
If we answer all the dispatcher’s questions, he or she will decide whether it is an emergency. However, ambulances cannot be blocked unnecessarily, as this will extend their access to patients requiring saving lives.
When we see a drunk man lying in the street, should we call an ambulance or rather not expose ourselves to an unjustified call?
If we see someone lying on the street, we have a duty to make sure they don’t need help. Approach, try to make contact, check if he is breathing. Even if he’s drunk but unconscious, we should call an ambulance and wait for her to arrive. Do not call an ambulance to a lying man because we saw him from the car and drive away. It happens that the rescuers arriving after a few minutes cannot find the victim because he has moved somewhere.
Such trips to the drunk, however, expose the emergency medical system to unnecessary interventions. It’s a bit outrageous. In addition, if someone, under the influence of alcohol, falls over and has any head trauma, he is immediately given a CT scan, while other patients who require such diagnostics wait months for it.
That’s true. It happens, however, that after being examined drunk, he is taken by the police to the sobering-up center. Then he bears the costs of staying in this facility.
How much does a paramedic earn?
If he works on a contract, it is an average of PLN 20 per hour. If for a contract of employment, on average PLN 2200 net per month. It’s very little. You have to remember that in order to become a paramedic, you have to complete a 3-year undergraduate degree, and after graduation, you must constantly train at various courses. It is responsible work that requires making quick decisions that can determine human life. Recently, due to more and more frequent cases of aggression, the profession of a lifeguard has also become very dangerous.
What types of attacks are these?
Both verbal abuse and beatings. Last year, a rescuer from the Provincial Ambulance Service in Katowice was beaten in Jastrzębie-Zdrój. An ambulance was called to a 30-year-old who was lying on the street. He became aggressive during the test because he had probably used legal highs before. As a result of the attack, one of the rescuers was hospitalized, where he had an ankle sprain and zygomatic bone injury. There were also knife stings.
Why are rescuers attacked so often?
The perpetrators of many beatings are drunk or under the influence of other intoxicants. But often the anger of the patients who wait in the queues also falls on paramedics. We are attacked by the victims themselves, but also by their families. We often hear insults for someone waiting two years for a specialist appointment or surgery.
How can you defend yourself? Are you allowed to take e.g. a stun gun with you?
No, it is forbidden by law to use such things. Many emergency stations are starting to organize self-defense courses for rescuers. The idea is to incapacitate the attacker.
When we call an ambulance, who decides if it arrives?
Such decisions are made by the dispatcher on the basis of a conversation and an interview on the phone with the person calling for help. By asking the appropriate questions in accordance with the procedures, he is able to determine whether it is necessary to send an ambulance.
Who is a medical dispatcher?
A medical dispatcher may be a doctor, nurse or paramedic with five years of experience in working in a hospital emergency department or anesthesiology ward, in a hospital emergency room or in a medical emergency team. It is a competent and experienced person.
Can the dispatcher make a mistake?
He should not. It often happens that the dispatcher sends an ambulance to a sick person who does not need it at all. This is because a lot of people know how to cheat him. If the caller wants, for example, a painkiller and lies about having severe chest pain, any dispatcher will then send an ambulance. Meanwhile, someone else may suffer from it. We have about 1543 ambulances in Poland and it happens that in a given operating area all of them are sent to patients, and the dispatcher receives a notification about an accident in which the injured require immediate assistance.
What are you doing then?
He is looking for the nearest available ambulance. In practice, this means that it can go from a very distant place. There are 42 control rooms in Poland. In the following voivodships: Łódzkie, Warmińsko-Mazurskie, Świętokrzyskie and Opolskie, one in each, and several in the other.
But after all, the regulations specify the time of arrival of the called ambulance?
Yes, in the city it should be 8 to 15 minutes, outside the city 15 to 20 minutes. Every year, an analysis is carried out in which cases and places this time has been exceeded. These analyzes sometimes force changes to the territorial divisions assigned to individual emergency medical stations.
Rescuers announce that they will fight for pay increases. How are you going to do this?
We cannot stop saving lives. It remains to flag, put on T-shirts with information about the protest. We can also make a picket in front of the Seym, or the health ministry and voivodeship offices. We are the smallest group among the medical professions. There are about 15 of us, while there are definitely more doctors and nurses (there are about 220 nurses alone). However, although we are few, we are an important link in the health care system.
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