31 May 2017
My out-of-ambulance placement has concluded, with two weeks at a secure mental health hospital, and in district nursing.
For the mental health placement I was on a specialist ward for adults with learning disabilities and associated aggressive behaviour. There are limited numbers of such specialist wards in the country, and I was keen to learn about the care and attention that people required.
As I was being shown around the secure ward on day one, a patient ran at me and started screaming. I didn’t know what to, but the staff were quick to intervene. These patients simply do not know how to react to new people and faces. This presented an array of challenges in communication and developing those interpersonal links with the patients. It took a short while but after gaining their trust, some were even asking to play cards with me. Every day the mental health nurses and doctors discuss patterns in their behaviours and have to assess the need for medication changes.
I spent time in the 136 suites; which is where there are secure rooms dedicated for people that have been detained under section 136 of the Mental Health Act (1983). Patients were occupying both rooms when an emergency admittance appeared at our door. A London Ambulance Service (LAS) crew had blue-lighted a patient who had been sectioned, along with a police escort of six squad cars. Of course I was intrigued to understand the need for such resources. The patient was a very large man who had turned against anything in his sight at a train station café. It had taken more than ten police units, including firearms, to detain the patient, and it was revealed that simply running out of medication had caused this outburst of behaviour.
The mental health nurses tried desperately to find a 136 suite for the patient to be accepted at; the nearest turned out to be more than 40 miles away. At that exact moment in time, not a single mental health 136 suite bed was available in the whole of London. It really showed me the pressure on mental health services in today’s world.
As well as this, I was able to go to ECT (electroconvulsive therapy). This is a procedure, done under general anaesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure with the desired outcome to treat mania and depression. I was able to cannulate the patients in order for the anaesthetist to give the anaesthetic, and I managed the patient’s airways with manual manoeuvring and basic airway adjuncts.
My final week of placement was with a district nursing team in the countryside, which was a nice change from central London! Each day was 8am-4pm with a different nurse. We drove to patients, carrying out primary and urgent care needs such as administering insulin for diabetics. I was able to get hands-on by changing four leg dressings for patients who had wounds, ulcers and cellulitis. Most patients were inquisitive about why a paramedic student was attending to their needs, but had responded with encouragement and well wishes when I told them I was studying a degree.
It was a fantastic week, which I think I was able to relate to a lot more because we were outside, going from house to house every day - much like ambulance work.
It has been great for us student paramedics to understand the role of different hospital wards and practitioners. Quite often you can attend a patient who has dialled 999 but doesn’t require emergency intervention by the ambulance services; they're more suited to specialist healthcare professionals such as GPs and district nurses. For now, it is back to university to start a new patient assessment and management module. However, that also means we are past the hallway point in our three-year BSc in Paramedic Science! It has gone incredibly quickly. I can remember starting my first day in the skills labs like it was only yesterday.