Patient Assesment – Practice What You Preach

If you think about our job, what is the MOST important part of EMS?

…Is it the ability to sink that uncooperative ET Tube in the impossibly anterior airway?

…maybe it’s the ability to analyze every bump, nook, and cranny of an EKG strip to come up with a life changing, working diagnosis.

Actually, it just ends up being a trick question. The most important part of our job, as EMS providers, is patient assessment. The assessment allows us to do both sides of our job properly and efficiently. Without it, we would truly be a bunch of “Mother Jugs and Speed” Ambulance Drivers.

In EMS we have two major aspects of our job. The first there is treatment, then transport. Treatment tends to be at the forefront of our minds. We go into calls already running through treatment algorithms and protocols based solely on the dispatch complaint. This way, we are better prepared for the decisions we have to make, once we actually have made patient contact. I have two major problems with this train of thought. First and foremost, it causes tunnel vision. It only allows you to see the signs and symptoms that point towards your diagnosis that you have thought about in your head. This is very similar to when police officers only see the evidence that fits their theory of the crime, or the evidence that points to a particular suspect.

The second major aspect of our job is transport. Gone are the days of “scoop and screw,” to the closest hospital. We actually have to base our transport decisions based off of clinical evidence that supports why the patient needs the resources available at that facility. For example, why a patient with left sided facial droop, left sided weakness, and slurred speech needs to go to a stroke center as opposed to a standard community hospital emergency room. We also need to know our resources in our area. I am lucky enough to work within reasonable distance to some of the best medical facilities in the world. I know that I am taking my patients to some of the best facilities, and I know that I am doing them a true service.

If we take away our ability, or better yet, if we flat out neglect the ability to asses our patients then we loose the main attribute of our job that makes us clinicians. We wouldn’t ignore our assessments of our patients. So let me ask you this, why are we ignoring the assessment of our profession?

…yeah that’s right. I just slammed on the brakes, cut the wheel, and turned the bus around!

Being a Paramedic is quite possibly one of the most interesting, and exciting jobs I have had to date. For the record, I have worked as a Lifeguard, Police Dispatcher, Membership Service Rep, Camp Counselor, Maintenance Director, Maintenance worker, and last but not least a Pizza server. I truly come to work each day (despite what my evil, sleep deprived twin might say) looking forward to the challenges that will face me in the back of my 8’ by 5’ by 8’ office.

Why do we, as a profession, constantly accept the “mediocre” as good enough? When is the last time you looked at your paycheck and actually enjoyed seeing the hours to dollars ratio? When is the last time you have noticed how appropriately Paramedic and BLS resources are utilized? How about the last time that you complemented a patient for properly using EMS in the event of their acute misfortune?

Yeah, I can’t remember either.

That being said, lets talk about some ways to make this happen. The next time you debate taking the easy way out vs. the right way, choose the right way. That fight you just started with a nurse because she was too busy to take a report, or gave your some attitude because the needle gauge of your IV angio was too small, that set your profession back a bit. Make your decisions while on duty in the best interest of the job. Patient care comes first, image comes second, and attitude third.

Finally, in order to make the profession recognize and respected we need to get on the same level. The Federal Inter-agency Emergency Medical Services Commission published quite the extensive document showing how varied we are as a service, across the nation. It brings up all the vital statistics to show where we need to beef up, and where we need to scale back. It is important that we take the information in this document and use it wisely. The Fed’s have given us the material, brushing it aside and not following thru will be detrimental to our profession as a whole.

I hope these words gave you a little inspiration on this cold Sunday morning. Take care everyone, talk to ya soon!

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