Mobile Stroke Unit Ambulance Victoria with Waseem Siddiqui
Welcome to the second episode of The Brain Game Changer podcast. I am your host, Melissa Gough. In this week’s episode I have the humbled pleasure of speaking with Ambulance Victoria paramedic Waseem Siddiqui. For nearly fourteen years, Waseem has been impacting many lives in our community through his dedicated service.
We shine a light on the wonderful and specialised Mobile Stroke Unit (MSU), the first custom built stroke ambulance in the Southern Hemisphere, which rolled out in November 2017. Waseem also gives us a taster into his journey of becoming a paramedic, whilst also reflecting on some personal experiences, and sharing through his lens what his role can entail from day to day.
I feel the need to share that Waseem did this interview in the afternoon after finishing a night shift and in between picking up his children from school. I truly believe not all superheros wear capes!!
Links:
Follow @thebraingamechanger on Instagram
-
Melissa Gough 00:08
Hello and welcome to an episode of The Brain Game Changer, where heartfelt stories, awareness, and education can change the game. Each week we delve into the experiences of amazing humans, advocates and organisations from all walks of life, who share their adversities, the triumphs after tragedies, the milestones and those brain game changing moments right here in front of the mind. Through this journey together, we may find that we can learn some valuable tools, knowledge or education that will lead us into becoming game changers for ourselves, or someone around us or even for our community. My name is Melissa, thank you for inviting me into your space. It is great to be with you. Welcome to the second episode of The Brain Game Changer podcast.
In this week's episode, I have the humbled pleasure of speaking with Ambulance Victoria paramedic Waseem Siddiquu. For nearly 14 years Waseem has been impacting many lives in our community, through his dedicated service. We shine a light on the wonderful and specialised Mobile Stroke Unit, the first custom built stroke ambulance in the southern hemisphere, which rolled out in November 2017. Waseem also gives us a taster into his journey of becoming a paramedic, whilst also reflecting on some personal experiences and sharing through his lens what his role can entail from day to day. In talking with Waseem he's very passionate about what he does. He did this interview in the afternoon of finishing a night shift and in between picking up his kids from school. I truly believe not all superheros wear capes. So let's get into our interview. Good afternoon Waseem and welcome to The Brain Game Changer podcast. It is great to have you with us.
Waseem/Paramedic 02:11
Thank you for having me Melissa.
Melissa Gough 02:12
A paramedic's time is of vital importance. I so appreciate you being here, and personally, I just want to thank you for the amazing work that you do.
Waseem/Paramedic 02:21
Thank you very much, and I'm more than happy to be here. This is a great platform to promote these types of extra services that ambulance services do around the world.
Melissa Gough 02:30
When I first started putting this podcast together, one thing that I wanted to do is shine a light on the amazing work that paramedics do. You work tirelessly, you work many hours, you deal with all forms of life out in the community, and I'm sure every day is different.
Waseem/Paramedic 02:46
Absolutely. I've been doing this for just under 14 years now. The only days that are the same for me are when I'm in the office, because I managed a few teams. The mundane tasks of office work are still there. But when I'm on the road, basically, everyday is different. Every job is different.
Melissa Gough 03:01
You just segued well, actually because I was just going to ask for a little bit of a backstory. You've been a paramedic for nearly 14 years, can you talk us through the decision to become a paramedic during that time?
Waseem/Paramedic 03:14
I actually joined St. Johns Ambulance as a First Aid Operator, I think I was about 15 at a time or maybe 16. They came to our school. So my best mate and I, we both joined St. John's and ended up working with St. John's for a few years. I got to see what paramedics did, but still wasn't something that I was like, oh, that's what I want to do. But my best mate, he actually joined the paramedic course, a year before I did. It seemed interesting to me. I also observed ambulances and paramedics while working with St. John's as a First Aider. So I kind of knew what was going on. So he was telling me what he was doing, and I went, "you know, why not?" Let's have a crack. So I've never looked back since.
Melissa Gough 03:57
That's amazing. How did the transition to start working on the MSU come about?
Waseem/Paramedic 04:03
Yes. So everybody starts off as a what's called a Graduate Paramedic, so you do that for a year. So yeah, I would have been a paramedic for about nine years at the time. I did some other roles, including a little bit of management. I did clinical instructing, then this opportunity came up via a what's called Expression of Interest. You fill your details out, say why you want to work on it, and I just thought it was an amazing thing to have to do. The only one in Australia, the first one in Australia. I believe it may have been the first in the southern hemisphere. So I thought why not? This sounds amazing.
Luckily, I got accepted in the first batch. There were about 30 -odd paramedics and I got trained up to work. There's this specific trading regime, but also stuff like what you wouldn't think of because the ambulance is much larger, so we all had to get a licence upgraded to heavy rigid, sorry, medium rigid license. All that training was involved and then yeah, have been on it, since it started in November 2017. We don't work exclusively on the Stroke Unit. We will work in our normal areas, or wherever we are on normal ambulances or other roles, and then every so often you will come back for a month or two to do a couple of months on the MSU.
Melissa Gough 05:16
Okay, great. I'm just going to add to your comment, you are correct. This is the only mobile stroke unit in the southern hemisphere. There are only six countries in the world that have this form of access to this unit - Australia, Canada, Argentina, Germany, Norway and the United States. The first MSU unit was launched in Germany in 2008.
Waseem/Paramedic 05:40
Yep, that sounds about right. So the Mobile Stroke Unit, or the MSU is staffed by five operators. There's three operators from the Royal Melbourne Hospital, which consist of a neurologist, a stroke nurse, and a radiographer, to operate a CT scan, and there's two paramedics onboard. We respond to any stroke cases which come up within roughly a 20 kilometre radius of Royal Melbourne Hospital. In Ambulance Victoria, we have specific codings for separate jobs. There's a specific coating for stroke related cases, and a normal ambulance is dispatched as well as The Stroke Unit. Depending on what information comes through, in those calls, they get graded into different categories. It might be chest pain, it might be somebody who's conscious or unconscious, but there's a specific stroke coding as well. There might be because someone's saying I can't move the left arm or they have a headache, or they have numbness, or they can't speak properly, these type of symptoms might get coded as a stroke, and if within our radius, then we'll be automatically dispatched along with a normal ambulance.
The first ambulance normally gets there, they do an assessment, which would be a normal stroke assessment that we would do in any case, as a paramedic. They come up on the radio and say, yes, please keep the stroke unit coming, it looks like it is a stroke, it's in the last 36 hours, and then we keep the casualty contained. Once we get there, the neurologist and the stroke nurse will do an assessment, a neurology assessment that would happen in any hospital emergency department with the stroke clinicians. Basically, we can bring the CT scan to the patient to save some time from getting them from the house to the hospital for treatment. The idea is to try to treat them in the driveway.
Melissa Gough 07:45
It's like bringing the hospital to the patient.
Waseem/Paramedic 07:48
Yep.
Melissa Gough 07:49
When I had my brain haemorrhage, one thing I was not is an expert, I did not know much about it, there was no prior genetic history. You know, I must say the time saved is the brain saved in that first 60 minutes of that golden hour. Can you discuss what is happening to our human body on the onset of stroke in that first hour, that makes it so vital for us to respond and react?
Waseem/Paramedic 08:16
The more common sort of strokes are caused by a blockage. So, I am not talking about the haemorrhages, like the stroke that you had. A majority of strokes happen which is due to a blockage somewhere in the brain, that part of the brain is starved of blood. Anything past that blockage in the brain, you start to lose brain cells due to lack of oxygen, lack of blood, and those brain cells are not replaceable, so don't regenerate. We try to get a thrombolysis agent to break up that clot into the patient as quickly as possible, once you've diagnosed that there is a stroke happening, that's the main aim. As you said, ‘Time is brain,' we need to get that blockage cleared, so we can get blood flow going back to the affected areas. Obviously, that will also show up in the symptomatology of the patient, whether there's speech problems, movement problems, deficits, limb deficits, that type of stuff. That's what they talk about in the golden hour, trying to get the patient thrombolysed and the blockage cleared as quickly as possible. We try to stop that further damage so the brain cells don't regenerate so once the damage is there, it will most likely be there for a long time. Depending on how long the blockage has been there and how long the strokes have been happening, that also has a strong effect on rehabilitation. You know, staying in rehab wards, that type of stuff, learning how to talk, walking, all those factors, depend on how severe the stroke was.
Melissa Gough 09:44
You've now got the patient back in the ambulance, you are doing all these assessments, then you start making your way to the hospital. In that timeframe, is all this information sent to the hospital, so upon arrival, is the team in place or who's required in place a specialist to then move on to the next stage?
Waseem/Paramedic 10:06
Absolutely. So once we made a decision that this is a stroke, we track the stroke, the images are always sent back to the Royal Melbourne Hospital as it is, there's a collaboration within Royal Melbourne and Ambulance Victoria. Anyone at Royal Melbourne, any of the senior clinicians, can have a look at the scans if they need to make sure that what they're seeing is what they're seeing. However, it's not necessarily Royal Melbourne that we will always go back to. It's the closest appropriate hospital that has the facilities to deal with the patients symptoms and condition. So if we're looking to get a retrieval clot, which is basically going via a catheter through the groin, grabbing the clot and pulling it out. There's certain hospitals in the metropolitan Melbourne area that can do that, not just Royal Melbourne.
Depending on where we are, we might go yep,go ahead to say the Austin hospital, we'll head that way. The neurology team on board will discuss the job with the neurology team at the Austin hospital and say, Look, this is what we have, we're coming in. The whole point of this service is to bypass the emergency department. These patients have already been assessed, they don't need further assessment in the emergency department. If it's about going back to Royal Melbourne, obviously, the clinicians are from Royal Melbourne anyway. But they'll have a chat with the team and say this is what we have, we're coming back with this patient. Hopefully they can clear the space, they need to clear whether it's for surgery or wherever else they need to go.
Melissa Gough 11:29
There's so many benefits about MSU, and what's been fortunate is that in doing some research, I was really fortunate to be given this information from the media team. Of the 1920 patients that you've assessed and answered the calls to that required expert care with the MSU 39% of those patients had CT scans performed in the mobile unit, and then 199 of them received the necessary medications to dissolve dangerous clots. That's phenomenal! And it's a vital time for that patient.
Waseem/Paramedic 12:06
Absolutely. It's just amazing to see how quickly the patient is going to recover, once we've diagnosed a stroke and administered the medication or thrombolysis that we need to. It still amazes me now we've got a patient who can't move, who can't talk, you know, basically making no eye movements with us to communicate, and within 10 -15 minutes of being thrombolysed, are talking to us! They were telling us, I knew what was happening. I knew I couldn't talk, I knew I couldn't move my arm, but I just couldn't tell anyone about it. A lot of times you'll have a patient in the house who is dependent on everything, because they weren't able to talk, or move, or stand, and they're sitting up having a chat in a stretcher, while we're wheeling them into the hospital, it's just amazing to see that transformation, and how quick that is. That would have been time that there would still be having a stroke and still be having the damage to the brain, while we're trying to get them into the back of the ambulance, get them transported to the nearest hospital. Once you get into hospital, then the stroke team does assessments, then they get a scan, then a decision is made to treat. So we've saved that time by just being in the driveway.
Melissa Gough 13:19
According to your statistics and research, 50% of the patients who received the clot dissolving treatment on the MSU were treated in the first 90 minutes compared to approximately 13% in the hospital. So again, just reiterating how crucial it is.
Waseem/Paramedic 13:30
A lot of those delays will also be time to get them into an ambulance and then transplant to the nearest appropriate facility for that assessment to begin, which luckily can begin from within the lounge room of the patient while we're trying to sort of how to get the patient into the ambulance.
Melissa Gough 13:53
Is the MSU, is it available over a 24 hour seven days a week cycle?
Waseem/Paramedic 14:00
At the moment, the mobile stroke unit works from 8am to 6pm Monday to Friday, currently not working on public holidays as well. So just Monday to Friday for now. Hopefully this will expand in the future. There is a second MSU planned for 2023.
Melissa Gough 14:17
Oh fantastic!
Waseem/Paramedic 14:19
Yeah, so that way people will have a bit more coverage across the city. As you can imagine being based at Royal Melbourne Hospital, the 20 kilometre radius doesn't cover metropolitan Melbourne. The crews are getting a lot more aware of calling the MSU early if they get to a job that's out of the MSU catchment so they haven't been dispatched to go, or actually this looks like a stroke, can we get the Stroke Unit come in, even though the patient, the house may be 25 -30 kilometres away. By getting onto that early enough we can usually get very close to where they are by the time they manage to extricate the patient out which is a lot still. It is still effective for the patient because we can still scan, whether it's the driveway or whether the crew starts moving towards the hospital, so we meet them somewhere on the road.
Melissa Gough 15:05
Oh, wow!
Waseem/Paramedic 15:06
We usually meet them somewhere where we can safely get the patient into the back, scan them and make a decision. So it's like a moving stroke hospital, basically, just so we can get that scan in that all important scan, that decision as to where we go with this?
Melissa Gough 15:22
That's really exciting to hear that there's going to be another MSU unit available. You know, hopefully in 2023. One thing that's interesting, is, according to the World Who Organisation across the globe stroke is within the top three of fatalities in the world. So it's needed.
Waseem/Paramedic 15:42
Yeah.
Melissa Gough 15:42
We definitely need it.
Waseem/Paramedic 15:43
Absolutely.
Melissa Gough 15:44
It is coming through that you're very passionate about what you do. Like you said, you haven't looked back. The fact that you're still passionate and to such a worthy and needing role in life. Can I ask you, though, and this is probably a loaded question, because you've been doing this for so long, but as a community, we can be seeing paramedics probably on the worst day of our lives. So are there some examples of scenarios that still stay with you that you've experienced?
Waseem/Paramedic 16:16
Yeah, look, and you, you nailed that by saying that. We tend to attend to people on probably the worst day of their life, whether it's for a loved one or for themselves. As benign as it sounds, for us, it's another job, another patient. Now that I'm a bit older in the job, I do a bit more mentoring, I do tell the new graduates that come in, and say, look, for you, it's a chest pain, or somebody who's had a low blood sugar, or somebody who's having maybe a bit of a hard time with anxiety, depression, mental health, whatever. But for them, it could be the worst day of their life. So you still need to treat it as someone. A nana who's falling down the stairs, to somebody who's, who's withdrawing from medication, illegal drugs, all that type of stuff. For you, your job is just to go and look after the patient and make sure they feel like they'd be looked after. For us, it might be just another job in a cap, but hopefully for them, the one and only time they're going to use an ambulance service. So yeah, look, oh god, a job that I can use. I have to say in my time I've delivered 11 babies!
Melissa Gough 17:25
Awww, amazing!
Waseem/Paramedic 17:26
Every single one of them is just an amazing job. I have to say, luckily, none of these babies were born unwell or had difficult deliveries, the mothers all were fine. There's been no issues post the delivery, but I guess just delivering a baby into the world, it's, it's an amazing feeling! Maybe eight years ago now, maybe more, I remember going to this call. It was in the Bundoora area we would have been maybe five, seven minutes away from the hospital. I remember telling my partner, let's get her in the back and it's three o'clock in the morning, there's no on the roads, we'll just get her in the back of the ambulance, we'll get to the hospital. Then we opened the back door and basically the baby's head was crowning, I went, "no we're delivering a baby right here!"
Melissa Gough 18:10
Oh, wow.
Waseem/Paramedic 18:11
Then you start thinking about, obviously, you've got a mum who's delivering a baby in the freezing cold, we're going to have this newborn baby who's going to be very cold, and probably very wet. Because it was like a torrential downpour, of course, that's what happens when you try and deliver a baby! You just work with your partner and you get through it. But the feeling afterwards is amazing. Just to roll into a hospital with a mum and the baby, we'll come straight towards the maternity unit to make sure that everything else is fine. I reckon those are the jobs.
Melissa Gough 18:41
That's an amazing story. Thank you so much for sharing. I can only imagine what it's like in that moment, like you say, for everyone involved. You talked about your partner, I can imagine this is also the type of role like in the MSU, in a normal ambulance, that partnership, that connection between all of you is probably one of the tightest partnerships that you could ever have.
Waseem/Paramedic 19:07
Absolutely! You don't realise how much you need your partner until you need your partner. That can be from a job that initially started off as just mundane,everything is fine. It might just be a, I do remember one job that I was working with a really good friend of mine, where we managed to tee up a shift together. We just went to this elderly gent that had I think he had chest pain initially, but there was a bit of a language barrier. Both husband and wife didn't really speak much English. So we're trying to figure out what's going on, trying to see if we can call their daughter or a son to get help translating for us.
In the middle of this, the patient literally froze, collapsed and went into cardiac arrest! We knew he was not feeling well. We just didn't know why he wasn't feeling well and what was going on. So while we're in the middle of trying to do our treatment or assessment, trying to get, you know, ECG up and running, he's basically just collapsed into a cardiac arrest in front of us. Just in that moment of turning to my partner and saying, I think it's a cardiac arrest. We have to now start dealing with this cardiac arrest in the house with a wife now who's going to be freaked out and trying to get extra resources to our scene to give us a hand. I think that's one thing people don't realise or don't think about in the ambulance world is you're on your own with your partner, until you can get back up, which could be around the corner, luckily, but it could be 10 or 15 minutes away. But those minutes can feel like an absolute lifetime when you're dealing with a patient. Sometimes in my role, I work by myself, so respond to cases just by myself in a sedan, and that can be even more overwhelming. When something goes wrong, or a patient is really unwell to be there on scene by yourself, you manage what you can manage until you can get back up. But this is what we do, we love it, and this is why we do it.
Melissa Gough 21:02
Yeah, again, and I could say it over and over again, however, I am going to give an example. I don't remember what my paramedics looked like; there were two, a male and a female. I know their names, but I just remember the woman having quite a reassuring, mumsy voice. Even though I'm a woman in my 40s, there was something very comforting about that. I was in and out of consciousness and things were not looking too great there for a while. But to also comment on the type of human beings that you are. I was administered, admitted into the Alfred Hospital. It was a Sunday afternoon. I was in the ICU. I can't remember for at least 24 to 48 hours. The paramedic who was with me at the time of my haemorrhage, the next day was dropping off another patient, and actually came to look for me. Yeah, I sort of remember this, I was still really out of it, and very, very dosed on a lot of drugs at that point. I just thought that was really beautiful. Apparently, she said, "I've just come to see how Melissa is", and even though my hearing was very clear, she said "I knew something wasn't good." I apparently got very emotional at that moment. I just thought she didn't have to do that.
Waseem/Paramedic 22:22
I think that's the good thing about our job. In this job, and with other health services, the hospitals are very happy for us to follow up on patients. Because sometimes you do have that feeling, like that paramedic will be thinking to herself, I just know that something's not right with this patient. I don't know exactly what's going on, but I just know that there's something not right. The worst feeling is to take someone in like you, someone in their 40s or even younger, or even the elderly, but to take them into hospital and then go I don't know what's happening with that patient. I don't know if they're still going to be around, iff they survived, or if they've pulled through. Sometimes it's the follow up to go like it is good. I was thinking on the right path, or I'm just glad they're okay. It looked a bit touch and go at the time or and myself dealing with patients who've had subarachnoid haemorrhage sometimes doesn't always go as well, as it has for yourself, looks like your recovery has been amazing. It doesn't always head that way.
Melissa Gough 23:20
I'm very lucky, I fall into a category of about 30%, I still have some ailments. The main thing is the cognitive after effects and the trauma. I am not back in my full time job, I had to leave that, and here are things that I am dealing with. But I'm very aware and doing more research about how and which statistic I was lucky to fall into. That's why I wanted to do this podcast and shine a light on the amazing organisations and resources that are out there.
Waseem/Paramedic 23:53
I think I've been lucky in this mobile stroke world where I've had the opportunity to be, to manage it as well, for the last sort of two and a half, three years. In terms of talking with Royal Melbourne Hospital about high effective protocol on this, on the stroke unit and talking about new research that they want to do. Obviously training up more and more paramedics to work on the stroke unit. We'll need to do more training by next year. Once we get the second unit up and running. So I've been fortunate enough to be in that management role and see how it all comes together from the inside and have those necessary conversations with the people in charge at Royal Melbourne constantly.
We always talk about the stroke unit. It's also a bit, I guess it's very different for everyone because it's a collaboration between Ambulance Victoria and Royal Melbourne Hospital. We also have normal vehicle issues which can occur with ambulances. Unfortunately, unlike other ambulances where we can just drop it back to our fleet centre, swap over to a new ambulance and keep going. You can't do it with this one. Those types of issues that you can work through as the manager to see, how am I going to get this ambulance back on the road as quickly as possible? Sometimes, when it needs a service, it needs a service. I've been lucky enough and fortunate enough to be working in that role with the stroke unit.
Melissa Gough 25:26
That's right, and they're lucky to have your knowledge and your expertise. Like you've said, if you have witnessed it right from when you get the call, all the way to the transition to the hospital, we can all work in collaboration for the best outcome for everyone involved.
I'm going to ask you one last question. So the name of the podcast is called The Brain Game Changer: where heartfelt stories, awareness and education can change the game. If there's one piece of vital information, one golden nugget of advice or valuable information that you would like to pass on, what would it be?
Waseem/Paramedic 26:00
Oh, that's a good question! Probably follow your gut instinct, especially with your family members, with your children, with whoever it is. If you think there's something wrong, there may be something wrong. So don't ever feel bad about calling an ambulance or going down to the hospital or seeing a GP about something. I thought there was something seriously wrong with this, with you know, whoever it is. So just follow your gut, it tends to be right most of the time.
Melissa Gough 26:28
So true. So true gut instinct, that leads us into the right outcomes of where we're meant to be.
Waseem/Paramedic 26:34
So true.
Melissa Gough 26:35
Waseem, thank you so much. This has been amazing. I appreciate your time, and ow you can go and have some rest and be with your family.
Waseem/Paramedic 26:43
Oh, I will do the school pick up! I will rest soon. Thank you very much for having me on. These types of platforms are by really, really good and getting information out. I'm sure there's a lot of people around Melbourne that don't even know we have a specialist stroke unit. A lot of the times when we do rock up to a call, and people look around going, what's that? I responded with, oh, that's the MSU. Usually, the feedback is ‘ wow, I don't even know we had this in Melbourne. My usual line is"yep, and you're lucky because it's the only one in Australia at the moment. That's a good thing, I guess, that a lot of people don't know about it, because it means they haven't come across it, and I haven't had to use it. But it's also a good thing to know it's there, should they need it.
Melissa Gough 27:32
So true. I only became aware of it because of what happened to me. I did not know it existed. And since then, I'm so grateful that it does. It's unfortunate that they need it. But I'm so fortunate that it's available to them.. Thanks Waseem. Take care.
Waseem/Paramedic 27:48
No worries. Thank you very much.
Melissa Gough 27:55
I want to thank you for listening to this episode today and supporting The Brain Game Changer and the guests we interview. I hope it adds some reassurance or valuable tools no matter how big or small, that will continue assisting you in being the wonderful game changer that you are. The best way to support the Brain Game Changer podcast is to like, share with family and friends or subscribe. So each weekly episode is easily available to you. I'd love to hear your feedback. And you can also find me on Instagram @thebraingamechanger. Drop in and say hello and check out the regular posts about awareness and education on various important topics and issues. Until next time, take care.
