Showing posts with label Assessment. Show all posts
Showing posts with label Assessment. Show all posts

Rose by any other name...

The title is not a typographical error or omission, I meant it to play on the line from Romeo and Juliet.
In the Shakespeare play, Romeo proclaims that his love for Juliet transcends their family names and political differences by saying

"...That which we call a rose
By any other name would smell as sweet."

And this line certainly conveys that feeling, as does the rest of their exchange, but try calling Rose, your 78 year old patient, by another name and let's see if she stays as sweet.

It can not be repeated enough so I will keep repeating it until I either snap and become un-Happy or until I stop hearing certain words at the scenes of emergency responses.

If you choose to use profanity I have issues with you.

If you use inappropriate terms to describe ethnic groups, I have issues with you.

If you can't learn and use your patient's name then we not only have issues, but you are lazy.

Things I have heard on scenes throughout my travels are terms like Pal, Buddy, Honey, Sweetie and my least favorite, Dear.

Let me assure you I have fallen victim to the occasional frustrated or suddenly confused Buddy or Dear comments, but constantly using such terms only proves you don't care enough to even learn their name.

And another point of clarification, while we're on the topic of names, your patients are not expected to remember yours. Notice I said remember, not learn, because of course we are introducing ourselves to our patients, then using the names they tell us to address them.

Aren't we?

When entering a scene keep in mind what you look like. Uniformed, carrying bags, wearing gloves, possibly even a mask and asking questions. Not to mention all that ruckus outside. That's scary. Not just for the kiddos, but everyone.
Now imagine the confusion when I come racing up the stairs in full turnouts fresh from a fire call doing the same thing.

So when you approach these folks, put them at ease from the first words out of your mouth.
I prefer a simple phrase like, "Hi there" or "Good (afternoon, evening, morning)" just to remind them I'm a human being too.

Now to the tricky stuff that comes from experience, the introduction.
"What's wrong?" is a poor opening line,
"What happened?" can lead down roads not concerning the present Chief Complaint, and
"Why did you call 911?" often leads to people looking away and saying "um..."

Start by offering a hand and simply saying hello, then your name. When they reach to shake in introduction not only do you have an ABC assessment complete, but you make them smile and feel at ease.

Now remember the name they give you.

Repeat it to them.
"Hi Jessica, how did you end up on the floor today?"
Write it on your glove if you must, but remember it. Use it. Call them by it.

If Jessica introduces herself as Mrs Johnson, you call her Mrs Johnson until she tells you otherwise. Not Jessica and certainly not Dear or Sweetie.

Not using a patient's name when speaking to them shows not only disinterest in your patient but disinterest in your profession.
If you lose the trust of your patient then all you are is an expensive ride.
Earn their trust and do it from the beginning with a smile, an offer of a hand, a hello and referring to them by their name.
It's a little step that goes a long way and will not get you noticed when you do it, but will stand out glaringly if you don't.

Imagine if Juliet showed Romeo the amount of interest many in EMS do and called out,
"Buddy, Guy, oh where for art thou Pal?"

I think Romeo would have turned tail and found someone that could at least remember his name.

--

Speaking of names, I broke my own rule there didn't I. I'm Justin Schorr from HappyMedic.com and the Chronicles of EMS, a recent addition to the contributors here at Paramedicine101.
It is an honor to be considered worthy of inclusion in such an influential forum and I hope to live up to the standard set by those who came before me.
You can reach me at thehappymedic@gmail.com with any questions, comments or concerns. So until next time, see you in the interwebs.

Future Priorities for Parameidcs - Assessment or Interventions?

Firstly, I would like to say thank you to Paramedicine 101 for the invite to start posting some of my thoughts on this blog. I am flattered to be asked, and I look forward to having some discussions with some new readers about my thoughts and musings.


This post is a combination of two that I have had over at my blog this week, and I post it here as I would like to have your opinions too....

I have just finished reading a fascinating short article over on EMS1.com by Brian Bledsoe, entitled'Speed and Time in prehospital trauma care'.

I figured that I should read it as I am due on the EMS garage podcast in 20 mins and we will be discussing it!

However, it has left me with more questions that I expected.

I am already aware of the recent move to disprove the concept of the Golden Hour, and when I have been talking to colleagues at work about it, I have basically said that all it proves is that if your injuries are going to kill you, then it doesn’t matter if you are on scene for 10 minutes or 30 minutes (or so the current thinking is telling us), and likewise if you are going to survive, then you will unless you are kept out of the hospital for a significantly prolonged period of time.

I know that this goes against all of our training and is pretty much against the core values of how we look after our trauma patients.

But....

It has also got me thinking about other things.

Mrs999 and I have just had a conversation about it, and I came to a conclusion that I want to put out there and I would love to hear your thoughts on it.

There has and always will be the need for an ALS component to pre-hospital care. However, in the future (very near future in the UK already) will an ALS provider be defined by his or her 'intervention capability' or will a true ALS provider be defined by their assessment and diagnosis ability.

More and more in the UK, we have more varied options open to us for our patients. If I have a patient who is having a CVA, they go to a certain hospital or unit. An M.I will go to a different unit. Potentially significant head injuries go to one hospital whilst 'less' serious head injuries can go to a normal A&E unit. The list goes on and on, but shows that it is becoming more and more the paramedic’s responsibility to actually provide a provisional diagnosis to base their transport decision on.

If you get it wrong, then you can place your patient at risk by taking them to a hospital that may not be equipped to look after their needs at that time.

It also moves into the realms of minor injury and illness. Our experienced paramedics can 'treat and refer' or' respond not convey', which is completely reliant on a sound and thorough clinical assessment and a professional and eloquent patient care record.

Just take a look at how often you pull out the magic box of ALS tricks and be honest and see how often they actually make a real and significant difference.

Now, don’t get me wrong, I am not saying that we should lose these skills and interventions. I have seen the benefit of them, and they are the times where we really, really feel good about what we can do and the differences that we make. All I am saying is, as we move forward with EMS 2.0, what really is the most important tool in our repertoire?

Is it our 'awesome' intubation, cannulation and drug therapies?

Or, is it our ability to make a clinical diagnosis, based on highly developed assessment skills and move our patient to the correct place for them to receive definitive care?

I agree that treatment and assessment are intertwined and to be an efficient and effective EMS provider, you need to be proficient at both, but I also think there is another way to think about it.

Are we now getting close to the limit of what we can do with interventions for our patients?

I for one cannot see much more that would be of benefit or that would be practicable to try and perform in an out of hospital setting with our current level of technology (who knows ones we get into Star Trek land though!).

I have been on a number of courses around assessing and treating a patient suffering from traunatic injuries (ATLS, PHTLS), but there are very few advanced general assessment courses, primarily aimed at the medical patient for me to go on.

If we take it as I said that we cannot physically do much more for our patients, then should we now be looking at where we can go to further help our patients by concentrating more on our assessment and diagnostic abilities?

Or maybe I am just barking up the wrong tree??