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 EMS12Lead.com
http://ems12lead.com/2010/06/81-year-old-male-cc-cold-and-shaky/
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!
It's hard to say Craig. We can all wonder if the patient presented as a typical BP check or if any effort whatsoever on the crews' part would have revealed the need for an EKG. Whenever I get a request for a BP check, the first thing I ask the patient is if they are experiencing anything out of the ordinary or if they are simply keeping an eye on their pressure.("I normally stop by Walgreens twice a week and use the machine, but I haven't been by there this week.") His vital signs didn't raise a red flag and he apparently wasn't having enough discomfort to stop him from jogging down the street a couple of hours after being seen at the station.(Is it possible that an EKG earlier would have also shown normal?) Maybe we have reached a crossroads in EMS where, due to the advancements in training, technology, and legality, we can no longer simply take a BP and send them on their way. We will have to call dispatch to start an incident number, do a complete assessment, and fill out a PCR complete with a signed AMA refusal.
ReplyDeleteCraig, as one of the only 2 EMS blogs I read, I think you really hit the nail on the head with this one.
ReplyDeleteIn the modern US, the paramedic is the only healthcare provider that sees the patient in their home environment. There is much that can be elucidated from this information that will completely change the ultimate outcome for patients. From initial dx to ongoing healthcare after discharge, which will directly reflect on how often they call back.
In addition to suppllying this information though, paramedics can also share their interpretation. Some agencies like to take pictures of crash sites to turn over to the ED, but even with the pictures, a lot of important information is lost.
You don't need to be a medical specialist to understand and convey your impressions on mechanism or history of present illness.
Strong work, hope to see more.
-Veneficus