Three calls today, didn’t touch one patient

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The closest I came was when I used my 20 words of Spanish to determine that a woman had a headache, not chest pain. Which the 2 1/2 EMTs on the call couldn’t figure out in the 5 minutes they were on scene before we got to the call. The 1/2 is an EMT recruit and that’s being generous. I asked the husband about three questions, which used up almost all of my Spanish. Since I know my Cabeza from my Corazon and know what dolor is, I was all set. I even remembered how to say when in Spanish. Which seemed to be at least 18 more words than the BLS guys knew. The husband would answer me in English, but only if I asked the question in Spanish. I guess it was a test and I passed.

Four calls yesterday evening and the most exciting thing I did was start a 24 ga IV in the back of a nice older lady’s hand. Which I thought was pretty good myself since she had tiny little veins. We also worked up a guy with a very complex medical history, especially the part where he’s had multiple PEs. Which sort of leads me to a mini rant.

We never should have worked that guy up in the first place. Not because he didn’t have potential to be really sick. No, it was because he wasn’t sick and the BLS guys had him in the back of their ambulance and were less than two minutes from a famous hospital. Despite being with the guy for about eight minutes before we found them, they didn’t even have his name. The 1/2 EMT (a different one, but they’re interchangeable) took BPs on both arms and got a 40 point difference. Which was worrisome until my partner took the BPs and got a 6 point difference.

Speaking of my partner. She’s a fairly new medic. Very bright, too. The problem is that she’s one of the new breed of medics, which I call junior cardiologists. She does a 12 lead on just about every medical patient. Which means that every call takes longer than it should. I’m a big proponent of 12 leads and was an “early adopter” when we started doing them. Which was just about the time she was hired by us as an EMT. Or graduated high school. I forget which. The difference is that I won’t do them on patients that I don’t think are having MI signs and symptoms. How do you tell? By talking to, listening to, and looking at the patient. The risk of course is that you’ll miss an MI, and I have done that. So have medics that do 12 leads on every patient. It’s going to happen. Same with cardiologists and emergency physicians.

Anyway, this guy looked a bit sick, but frankly given his confusing history and marginal physical findings we opted to continue the O2, try an IV and go to the hospital. We spent 10 minutes on scene just trying to figure out what was going on because the 1/2 EMT’s story was useless. Which was 8 minutes too long given how close we were to the hospital.

I discussed this with my former partner at shift change. He’s worked with her way more than I have and he agreed. Too much emphasis on looking at the squiggles and not enough examining the actual patient.

Which seems to be the trend with newer medics and EMTs. Things like using the pulse oximeter to get a pulse as opposed to, you know, actually touching the patient. Or doing a second finger stick after giving D50 instead of talking to the patient to see if their mental status is where it should be. Nothing beats examining the patient, which entails touching them, listening to breath sounds, and a little poking and prodding.

What a novel concept.

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.

5 COMMENTS

  1. Dude! Finally! Someone else who agrees that the focus should be on the patient instead of the damn machines!

  2. I agree with most of what you said. But, as with most of medicine now days, you have to somehow be able to prove that you made a difference. Hence, the 2nd blood sugar check. Yes, you can document an improved level of consciousness, etc., but what is better to prove that you did some good than a higher number than when you started? It’s all about CYA today, my new friend…

  3. revmedic,Is documentation of a higher blood sugar NUMBER more important than documentation of an improvement in patient presentation?The patient presentation is the whole reason for giving the D50W. Don’t claim that it is the low blood sugar NUMBER – if your glucose measuring device were broken, would you withhold D50W from this patient?No. You would give D50W. But, suppose you have a patient who was a passenger in a car involved in a collision. He appears uninjured. He wants to refuse care, but agrees to an assessment. Since he is diabetic, you check his blood sugar. If this patient is behaving appropriately, can count down from 100 backwards and by prime numbers, but suppose your glucose measuring device were to give you a low reading, for example 25 (when 70 – 110 is considered normal, this is grossly abnormal), would you give D50W to treat this NUMBER?I would not.Reality is not the machine produced number, but the human produced assessment. You could recheck the bgl, but suppose it remains at an indicated 25? Do you push enough sugar into him to turn him into a gummy bear?

  4. EMS is not about proving that we made a difference. Research on the benefit of EMS has not been able to show a benefit for most of the treatments we use.Back to the original post,Sometimes it is hard for people doctors, nurses, medics, basic EMTs, to realize that the closest ALS is at the hospital. Delaying care, just so that the closest “prehospital” ALS can play along, is bad patient care. Patient care is not about manners and making sure that everyone has their turn treating the patient. If the prehospital 12 lead shows a STEMI, the patient should be able to by-pass the ED and go straight to the cath lab – no telemetry of ECGs, no stop in the ED for another opinion – just straight to the cath lab. Is this rude to the ED? No. It is just doing what is best for the patient.Even if we do 12 leads on every patient, we will miss an MI. They even miss them in the hospital with all of the cardiac enzymes to look at, in addition to the repeated 12 leads.

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