Sunday, February 24, 2013

The Paramedic's Most Important Job

The single most important role a paramedic can play in any patient's healthcare experience is to properly set the stage.  Yes, we must all be proficient in the recognition and treatment of immediate life threatening conditions, but that is just the beginning. Unfortunately this is the area most paramedics mistakenly concentrate all of their efforts. Have you ever heard a paramedic say something like this with a confident tone, "Nothing to that one! Show me something like V-Tach or SVT and you will get my attention." This attitude couldn't sicken me more. Every patient should have all of your attention for the entire incident.  The most underutilized skills I see in prehospital medicine are compassion and a good thorough patient assessment.  The topic of compassion is for another blog.  Today I want to talk about setting the stage and patient assessment. Setting the stage is done by performing a good patient assessment and interview, observing the surroundings and living conditions of the patient, and passing along the information, as well as, your opinion of the underlying cause to the receiving physician.  Paramedics were intended to be the eyes and ears of the emergency physician and I think we have strayed from that mindset.

The future of EMS is bringing the emergency room the the patient's living room.  With overcrowded hospitals and wait times growing we need to train the nations paramedics to think and act like physicians.  When an EMS provider examines a patient in their home they need to have a high index of suspicion for any condition that warrants further evaluation in the hospital setting.  When paramedics transport a patient to the emergency room they need to observe the initial actions and evaluations of the receiving physicians.  If the paramedic's assessment did not agree with the physician's assessment then I can guarantee you one thing.  One of them has something to learn.  If the physician performs any treatments or interventions in the first five minutes after paramedics transfer the patient then ask yourself, "Should I have done that? Is that something we can incorporate into future EMS protocols?"  The profession is it's own worst enemy.  I have heard too many paramedics say, "Why do I need to know that? It won't effect my treatment of the patient."  A more detailed medical education may not effect what treatments we allow paramedics to perform in someones living room, but it will give paramedics the knowledge to assure no patient is left at home with a potentially life threatening condition.

I just read this blog on Facebook from

Its an interesting EKG but all I see is that paramedics let a STEMI walk out their door.  Why did that happen?  Was their index of suspician high enough for this situation? Should they have performed a more detailed patient assessment? Should they have asked different questions or performed more diagnostic tests?  I think in hind sight we can all answer these questions.  Don't let it happen to you.  Be curious! Be inquisitive! Ask more questions more often! Don't rest until you understand!