An Interview with Robert Cocks MD

Photos are the property of Robert Cocks, used with the permission of Robert Cocks

How long have you been a doctor, and how did you get to where you are today?

I studied at the Royal Free Hospital School of Medicine in London from 1976-1981, so I have been qualified for 31 years now! For the first 9 years I trained to be a Consultant in Accident & Emergency Medicine and I worked in this field until 2001 in the UK and later in Hong Kong. The following year I did a six-month full-time course for the Diploma in Aviation Medicine and I have worked in that specialty since then. The reason for the change was my fascination with flying, and it followed an exciting project in which we started putting A&E doctors onto the emergency helicopters in Hong Kong. I was hooked on the combination!

What does the job mean to you?

A&E was an exciting and fulfilling area to work in and I loved the variety and immediacy of the problems that came in through the doors every day. However, it is stressful and very much a young person’s specialty – I saw so many colleagues burn out that I thought carefully about how I could remain sharp as I got older, and I think my move to Aviation Medicine came at the right time. I now work with a fascinating group of patients – airline pilots – and they are prone to just the same diseases as earth-bound mortals. My job is to keep them flying safely.

What kind of a community do you have at work?

My pilots come from all over the world and I socialise with them and with colleagues from a wide range of jobs at Cathay Pacific and at the Chinese University of Hong Kong, where I was formerly Professor of A&E Medicine. Hong Kong is a very multicultural place and that is one of the best features – meeting interesting people from so many different origins.

Do you feel that you’re always a doctor, no matter whether you’re on call?

Unlike some doctors, I do not feel that I am defined by my job. There is a danger among professionals that they tend to put their job before their families, and although I have been forced to spend quite long periods away from my own family, they always come first. When we come across an emergency or an accident, my kids have always been the ones to tell me to go and help, so I’m not allowed to ignore the situation and walk or drive on by !

I am not a very good patient – I tend to think that illness only happens to other people and I don’t adopt the sick role very easily, so I get accused of not following my own advice…

Most powerful experience? I have been privileged to occasionally save a life and that is a powerful kick every time. Also, I can never forget the times I went out to help rescue people from under London Underground trains while working at the Royal Free. My powerful experiences have been overwhelmingly positive, and the tragedies I have witnessed have been easier to bear because of the wonderful camaraderie that is common among A&E staff.

Featured Image Source: Photo is the property of Robert Cocks, used with the permission of Robert Cocks

This is an account of jeramedic, a young paramedic living and working in the United States. He is not a seasoned paramedic of forty years, bitter with experience about the  service, but nor is he a green recruit fresh out of training with no stories to tell. He is in a grey area in between those extremes, hardened by those experiences he has had but still proud of his profession.

Attributed to Jeramiah Bush, used with the permission of Jeramiah Bush

I thought I should write something that would be both personal, and general to the industry. Something that gives you, fine reader, a glimpse at what it’s like. So first off, a bit about me, and where I work. You know, just so we can get to know each other. I am a Paramedic in America, and at this moment, I am twenty six years old, and have been in EMS for six years. I work in Los Angeles, which is a very, very large and diverse place. If your only understanding of L.A is what you see in the movies, then you may think it’s just Hollywood, the beach, and gangs… Well you’re wrong. L.A county is so much more. The population is pushing 10 million. And in a area of 4,083 square miles (10,570km2) there is enough room for 8,000 foot mountains, miles of coastline, desert, a skyscraping metropolis, and people and cultures from around the world. Or yeah, and Hollywood. It is a truly unique place to live and work.

This job is like no other. It takes a certain kind of person to willingly go through the process, and sacrifice of training, hiring, and of course actually doing the job. It is one of those things where you have to enjoy every part of it. If you enjoy it, and it suits you, then it will be the best job you will ever have, and the idea of doing anything else is just ridiculous. But if it’s not for you. It’s the worst.

This is not a heroic job, although it may look that way. This is a privilege, this job is also about trust. Where else could one work, where a parent would give their sick or injured child to two strangers in a van? That’s trust. And it is the privilege that people give us to protect them. You see things that most will never see, or never want to see. In one shift you can deliver a baby, and then witness death. You will see the very best in human compassion and love, and the very worst of violence and evil. All in a day, and the go back to your home, as if nothing happened.

It is the misconception of many that this job is full of pain, drama, and tragic accidents. And yes, terrible things do happen, but not every day. Most calls are minor accidents, or people feeling ill. Not every call is for a bus of children that crashes into a puppy rescue that’s on fire.

In the U.S, EMS has an interesting history, and is thought of differently then in other parts of the world. Here, I lovingly say that we are the bastard child of healthcare, and the foster child of the fire service. We fight for identity and recognition. We are Paramedics, which means we practice Paramedicine, which is medicine. We are not ambulance drivers. Just as Police officers are not police car drivers.

We are trained and educated professionals, that are expected to act in a moments notice, and in a matter of minutes, ask a few questions, and fuss about with your body, and are to know exactly what’s wrong with you, and how to fix it. And all at 4am. And you know what? I am proud to say that is exactly what we do. That is one my favourite parts of the job. Is being the first one there, and being able to really make a positive impact on someone.

Some like the job because they feel it is a way to give back to their community. It’s now only recently that I have been interested in working in the same area I live. For years I have had about an hours drive to my station. It meant work was left at work, both mentally, and geographically. The drive into work gave me time to prepare for the shift. And equally time to reflect, and decompress on my way home. After working in the same area, for any length of time, streets and buildings can start to collect ghosts. Having that separation was one strategy to avoid bringing the ghosts back home.

But for all it’s drama and stress. For all the sleepless nights. For all the danger, and absurdity. It is in this job that I find meaning, experience, adventure, entertainment, and family. The pay is just a bonus. Now how many careers can you say that about?

Have you got experiences you would like to share? tweet as  @helloemergency

Featured Image Source : Photo by Jeramiah Bush, Used with the permission of Jeramiah Bush

So far we have established that university is one possible route to towards the world of paramedics. But what else is there?

The other option is getting on through an NHS trust. This is also a surprisingly difficult path as many of the trusts have had a ‘glut’ of applications in recent years and can’t afford to take more trainees. Many trusts also have the ongoing problem of budget cuts.

But what are the nitty gritty bits of becoming a paramedic I hear you say? Exams, interviews? How do you actually get into university to study to become a paramedic? That kind of thing. Well you can find all this out on the website http://www.howtobecomeaparamedic.co.uk/ and get their DVD and book with all the insider information on how to become a paramedic for £12.99. Should there really be a charge for how to become a paramedic-shouldn’t the be process more standardised?

The thing that struck me when looking up the details of paramedic of how to become a paramedic was how convoluted it all was. Although the NHS website provides quite a lot information it is all very general. The website is also hard to negotiate. There is very little information from people already in the business. The only article I could find was here on the Guardian website. The one place that seems to be a house of information you have to pay for. Also the titles of many of the courses at the universities have different names sometimes they are called paramedic science, sometimes paramedic studies which presents quite a confusing picture.

There are also very few options for those who can’t go to university. You essentially have to keep applying to NHS trusts to try and get a place or any kind of position within the ambulance services and hopefully work your way up from there. While I appreciate that they need to weed out people who simply won’t make the grade, should starting out really be this hard?

There is also nothing for anyone who is at the very start of becoming a paramedic, an idiot’s guide essentially. Perhaps there should be?

Are you training to be a paramedic? how are you finding it? Please let us know @helloemergency

Next up in this series of Hello, Guides: How to be a firefighter.

Featured Image Source: Simon Lamrock from London UK [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], Used with his permission via the Wikimedia Commons

Speaking to people who have spent years in the emergency services has made me wonder how many of them got started. Paramedics for example, how exactly does one become allowed to drive in an ambulance and how long does it take? Here is what I have found.

First and foremost, what does a  paramedic actually do? I mean officially what is this job description? We’ve seen the movies where someone is getting paddles out or driving off in ambulance but what else does the job entail? According to the NHS paramedics are ‘senior ambulance service healthcare professionals at an accident or a medical emergency’. Ok fair enough, but what how does one become a ‘senior ambulance…professional’. The answer is… with difficulty.

Originally, those who wanted to go into the ambulance service could work their way up through work experience and additional training eventually going from ambulance technician to paramedic. However, this route isn’t possible anymore.

If you want to be a paramedic you now have to secure a student paramedic position with an ambulance service trust, or attend an approved full-time course in paramedic science at a university. You also need (shockingly) a valid drivers licence and to register with the Health Care Professions Council.

The amount of things you can study as a paramedic is also huge. According to The Complete University Guide website. Studying to be a paramedic can include

• Biosciences
• Pharmacology
• Psychology and Communications
• Ethics
• Law
• Social Sciences
• Health Promotion
• Medical Design
• Technology
• Clinical / Professional Studies
• Clinical Skills and Behaviours
• Applied Anatomy
• Applied Psychology
• Structure and Function of Contemporary Health Services
• Driving Emergency Service Vehicles
• Accident and Emergency Care
• Managing and Facilitating Appropriate Options for Patients
• Managing trauma and Environmental Emergencies
• Recognising and Managing Illness
• Maternity and Paediatric Care
• Pathophysiology
• Practical Placements can make up up to 40% of the course

Courses vary in length from 8 months to four years.

There is no obvious top 5 guide to which place is the best to go to study to become a paramedic. But as far as I can see one of the most highly sought after places in St Georges University in London. This is largely due to the fact that the course works in conjunction with the London Ambulance Service (LAS) and LAS is the place to work to become a paramedic.

For more details on how to become a paramedic look for part 2.

Featured Image Source: http://en.wikipedia.org/wiki/File:Star_of_life2.svg, Star_of_life2.svg belongs to Verdy p, the image has been used with the permission of Verdy p through a wikimedia creative commons licence

@Secret_Medic kicks off our debate over Channel 4’s new series, Party Paramedics:

2011 saw a slew of stories about what we call “alternative care pathways” for those a little more inebriated than they had intended. For a while I was beginning to think the London Ambulance Service booze bus had its own media team with it at all times!

But thankfully that is over no-….oh, not quite.

The first episode of Channel 4’s three-part Party Paramedics series was set in Colchester – a notorious party town where a bus has been equipped to deal with the weekend casualties of the UK’s binge culture. The SOS bus parks up in the town and helps give advice, look after and sober up a few of the revellers. It is manned almost (if not totally) by volunteers.

I should preface my comments by saying that volunteer groups such as St John’s and The Red Cross do some fantastic work. And the volunteers on this programme should be commended for going out on a Friday or Saturday night, giving up their time and helping what most people (and not just Ambulance staff) would see as money draining time wasters who have gone too far in the name of forgetting their 9-5 working week. However it appears that none of these people was a Paramedic and this is where the issues began for many people who work in the Emergency Medical Service (to use an American term).

For those that don’t know, the title of ‘Paramedic’ is a protected one. This means that no one can legally call themselves a Paramedic without being registered as one. In the UK you must be registered with the Health Professions Council after around three years of training.

Paramedics are able to perform procedures that previously would only have been done in hospitals and manage to perform those procedures often very effectively in a heated, uncontrolled environment. For any junior doctors struggling to put in a cannula, try putting one of your first in, in the middle of the street with a crowd of a couple of hundred watching while you, your crewmate and a responder try and revive a patient in cardiac arrest! And more often than not, it gets done and done right.

For this reason I think it was a bad start for most of us ambulance folk to see these people working under this title and it was an ill-advised choice by Channel 4. We shall see whether they rectify this with the next two programmes.

The first episode was a mix of the good and bad. It was lovely to see many caring, nice people looking after the drunks for no reward and I think this shone through the program. Initiatives like this are vital in the modern world, because these people would have otherwise called ambulances taking away the vital resources from someone seriously ill.

But despite this heart-warming act of charity, I have some real concerns. Let’s assume for now that what we saw wasn’t heavily edited, as I cast my critical medical eye over these practitioners. There were two key cases where I disagreed with the course of action taken:

The first incident was where a lad had been bitten. It looked fairly superficial, and in fairness after some cleaning there is little else that can be done with it. The patient was sent home with advice to go and see his GP the next day. This might seem like reasonable advice, but there are some issues with this.

Given he had been drinking, will he remember the advice? And will he care enough to go? If I take a human bite to Accident & Emergency they will often – if not always – be given a tetanus shot.  This is due to the very real and dangerous risk of contracting tetanus. The advice should have been for this guy to go straight to A&E, even if they don’t take him there themselves.

The second issue came from the unconscious “Oompa Loompa”. I would say there is a very real chance this guy was on a substance other than alcohol. If you watch it again on 4oD you can fast forward to the part when he states he is an “Oompa Loompa on [PAUSE] alcohol.” The pause in that sentence is potentially very telling.

After the collapse, he is taken aboard the bus, but he is clearly confused. He doesn’t know where he is, doesn’t have a good grasp of simple information and in my professional opinion I don’t think this was simply drunkenness. The patient struck me to be in a similar state to what we call  “post ictal”. This is a state of confusion after having a fit or seizure and is usually temporary. It takes a varied amount of time for people to come round and regular fitters will normally recover and make their own way home.

But he had not recovered and was being left in care of another drinker to go home with the same advice to perhaps go to his GP. This is flat-out wrong.

It would be nice to know if they checked his observations thoroughly, as well as how much they know in terms of interpreting those observations  I will now give a quick list of possible reasons off the top of my head for why he could be like that: alcohol, drugs, seizure, diabetes (high or low blood sugar).

I’m sure a Doctor could give you a few more and for this reason that patient should have been conveyed to A&E.

My feelings on this kind of service are mixed. It is a marvellous service if done right. But I would have it run by a health care professional at all times, because although 999,999 out of a million times there will have been no issues, that one time they get it wrong (and I mean really wrong) it will jeopardise services like this across the country.

The media’s love of the booze bus could quickly turn to a hate for untrained staff treating people that need serious medical help.  Channel 4’s programme highlights how easily an innocent documentary can turn against an otherwise good idea.