Archive for the 'Good Medicine' Category



03
Feb
10

Frequent Flyer Benefits

Is there such a thing as Frequent Flyer Benefits? Yes there is, and I’m not just talking about flying across the country on the cheap either.

In this business, “Frequent Flyer” is a semi derogatory term given to those patients to whom we see often. They are the homeless alcoholics, the poorly managed type II diabetics, and the lonely widow. Anyone who has been in the field for a few months can tell you who their preferred customers are, and they know their address and chief complaint by heart.

These patient are not just the habitual 911 callers, but are also the weekly scheduled transfers like dialysis and chemo patients. I recently had a discussion about this with a good friend of mine. He is an administrator at a mid sized ambulance company specializing in inter facility transfers, and he has been dealing with a rather problematic trend amongst the field providers. He told me that  many of his personal were not doing assessments on frequently transported patients.

When he would ask why they weren’t doing full assessments, he was met with poor excuses like “Mr Johnson has CHF, he’s always tired” or “Ms Conner is post CVA, she’s always altered.”

This is a very dangerous  practice. I know at times it is tempting to think of our frequents as static characters that we give rides to. But that is  just  not the case . And it should be reiterated that for the time on scene and during transport, regardless of your level. You are the person that is most responsible  for that patient. And not doing a full assessment is frankly irresponsible and could cause harm.

So you ask where’s the benefit’s? , why should I be happy to be transporting this patient for the third time this week? well because you are at a huge advantage to provide really good care. You’re even at a greater advantage then the patients primary physician.

If you transport Mr Fillips to and from dialysis three time a week, that means you do six assessments a week on the same patient. That’s twenty four assessments a month, and one hundred and forty four assessments  every six months!  Do you think his primary physician, let alone anyone assesses this man health twenty four time a month? Probably not. And if anything was out of the ordinary, who do you think would notice first? You would. That is of course if you did an assessment.

When treating a frequently seen patient, we should pretend that it is the first time we have seen them. Sure you know their name and medical history but that’s where the familiarity stops. Afterward ask yourself  how what you found compares to what you know? Whats different or new about the patients presentation?

EMS, despite what it might claim is not an emergency service. At least not exclusively. Our place in medicine is quickly expanding in many ways.  If we can lose the “trauma junky ” hero mentality, and embrace our true role as Health Care Professionals. Then we will not only benefit ourselves as providers and our industry, but also provide our patients with better care.

So the next time Mrs Miller starts singing “ca’mon ta my my house, ca’mon ta my house” Be true to your role. Be kind to your patients. And give them the respect and attention they deserve.

26
Jan
10

Good Enough, Is Not Enough

when you think of a good EMT or Paramedic what comes to mind?

when you remember back on someone who influenced and inspired you, who do you remember?

I want to introduce you to two EMS providers.  we will call them “John” and “Jane”. Now John and Jane share many things in common with one another, but they are also very different.

They both work  for the same EMS service. They both went to the same school, and they both have been working in the field for  six years.  But this is where the similarities stop.

Lets meet John.

John arrives at work for all of his shifts on time, every time.  He attends his company’s mandatory CE trainings without a fuss and always keeps his certs and licenses current. He has good patient care skills and treats them appropriately for their illness or injury. At the hospital he is the model of efficiency. He gets his patients in a bed, gives report and is back in service in record time. He is also a training officer and preceptor. He promoted to the positions after only 2 years at the company. He Trains new employees and has students any chance he gets. And at the end of his shift, he leaves work at work. And knows how to relax on his days off.

Now lets meet Jane.

Jane is usually on time, but has been late on more than a few occasions.  She also attends the training classes and keeps up her certs. She has good patient care skills too, but has had meetings with her supervisors  about mistakes and breaking company policies and procedures. At the hospital she chats with the staff and tends to take a bit longer to clear. She is a training officer and preceptor as well, But she doesn’t see as many new hires or students as John does. And she is very picky about who she rides with. She bounces around the company, and has worked at every station. She doesn’t stay in one place with one partner for very long. When she goes home, she often thinks about  tough calls she had the shift before. And even on her vacation, it’s hard to get her mind off work.

Now who do you wish to emulate? who would you rather be known as?…… If  you said John, hold that for a minute. And lets look a little deeper.

John arrives at work for all of his shifts on time, every time. His shift starts at 0700, he gets to the station at 0658. 

He attends his company’s mandatory CE trainings without a fuss and always keeps his certs and licenses current. He is required to do 48 hours of CE, he does 48 hours.

He has good patient care skills and treats them appropriately for their illness or injury. He has too. Otherwise he’d be injuring and killing patients, have multiple  lawsuits against him and he’d lose his job. 

At the hospital he is the model of efficiency. He gets his patients in a bed, gives report and is back in service in record time. He hates being out of the station and wants to get back to the football game and then take a nap.

He is also a training officer and preceptor. He promoted to the positions after only 2 years at the company. He Trains new employees and has students any chance he gets. FTO’s get a 10% raise and preceptors get $1,000 for every student they have. He wants a new boat by next summer and thought he could make some extra cash.

And at the end of the shift, he leaves work at work. And know how to relax on his days off. He spends his weeks call bonus as beer money and gets drunk on the weekends, drinks when he can’t sleep and drinks when the bad calls come back to haunt.

Still thinking you want to be like John?

Jane is usually on time, but has been late on more than a few occasions. She’s on time because she gets to the station early to make sure the ambulance is stocked, fueled, and clean.  When she is unexpectedly  late she informs her supervisor and dispatch before her shift.  And  also attempts  to find someone to hold over until she gets there.

She also attends the training classes and keeps up her certs. As well as her required 48 hours, she also takes classes that interest and challenge her. And she teaches CPR and First Aid three times a month. 

She has good patient care skills too, but has had meeting with her supervisors  about mistakes and breaking company policies and procedures. She admits to her mistakes and learns from them. When she broke policy and procedure, she had a justifiable cause and did it in benefit of the patient. 

At the hospital she chats with the staff and tends to take a bit longer to clear. She consults with the doctors and nurses about the patients she brings in. She asks for others opinions and suggestions on the care she gives. 

She is a training officer and preceptor as well, But she doesn’t see as many new hires or students as John does. And she is very picky about who she rides with. She loves to teach. When there are new hires or a fresh crop of students, she take her time and chooses the ones that are struggling or needs extra attention.

She bounces around the company, and has worked at every station. She doesn’t stay in one place with one partner for very long. She has been able to experience a much wider variety of calls then John, because she has worked all over the city. She know everyone at the company and has many friends.

When she goes home, she often thinks about  tough calls she had the shift before. And even on her vacation, it’s hard to get her mind off work. She remembers the tough calls and reviews her text books, does research and thinks of way she can do better next time. One of her favorite times of the year is when she goes to EMS Expo

When you look at John, and realize that as skilled and accomplished as he is. He is doing the bare minimum that is required by law to keep his certs and not be fired or sued. That’s it…. the bare minimum.  The sad part is that in my experience, I have met many Johns. and I’m sure you have too. You could be reading this and realize “wait a sec, I am John!”  If you are John, I hope this is a wake up call. A kick in the pants to get you in charge of your life and your chosen profession.

I encourage you to get out there and be the change, be the example. Find someone more experienced then you and learn something from them. Find some less experienced than you and teach them something. Read a text book, read a medical journal, read a blog, READ ANYTHING. Go to conferences, take a class or two. Be proud of who you are and what you do. And do it well.

It’s easier than you might think.

10
Jan
10

Can I Get You A Blanket?

Today I read I great article by Greg Friese about cold weather response tips.  Greg writes that provider safety is number one, and of course I agree. Personal safety always comes first on any response, no mater what the weather. Ok, so we made it safely to the call. We are  wearing the appropriate gear for the weather and the type of call, and we have a safe and secure work area. Now what? Now we must try keep the patient as warm and safe as us. At the end of Greg’s post, he also has a short video showing how to keep a patient warm using sleeping bags and a plastic tarp. This is a great technique, but is better suited for wilderness medicine or extended rescue or extrication times.

Here’s  the deal. It doesn’t have to be -20 and actively snowing before you should  start thinking about keeping your patients warm. when our patients are ill or  traumatically injured, their ability to maintain an appropriate temperature is compromised. To compound that problem we remove their clothes, put them on a cold backboard or gurney, start to fill them with IV fluids that may as well have  come from a refrigerator and then take them outside into cold  ( unless of course the above was all performed on the cold ground and outside to begin with )  This is bad patient care plane and simple. Consider this: When  someone is cold, they shiver. Shivering yields poor EKG’s, it changes respiratory patterns,  and it increases oxygen demand. When someone is cold they will have peripheral vasoconstriction which makes it more difficult to start IV’s, it changes skin signs, it gives inaccurate SpO2 readings and above all when someone is cold, they are uncomfortable. There are some simple things you can do on your next call that can keep your patients warm and happy.

  • First, if your service has a linen exchange with your local hospital then use it. Stock up on extra blankets and keep two or three on the back of your gurney.
  • Use yourself as a thermometer. If you are cold, so is your patient.
  • Pad the backboard. this is something we should be doing anyway.
  • Only expose the patient as needed, and once you are finished with the exam or treatment  cover them back up.
  • If time and you patients condition allows, encourage and help them to dress warmly before leaving their house.
  • When you arrive on scene turn on the heat in the ambulance. After ten minutes it should be nice and toasty.

These practices are simple and effective.  It’s about taking care of our patients.  Not just clinically but as people. “Can I get you a blanket?” and “are you comfortable?” go a long way.

What are some ways you look after your patients in the colder months? Does your service have special protocols for cold weather operations? speak up! and stay warm out there.




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