On the Way to Paramedic in Northern VA
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Friday, April 20 2007
Street Cred <> Store Cred

From time to time, usually every month or so, the transport company hands out prizes by drawing names from a hat. The way to get one's name into the hat is by having a patient write an endearing letter to the company stating what a fine person one is, what a wonderful experience they had in being transported, etc. The person so honored has his name entered "once per praise". The prize is usually a $20 gift card.

This is a nice little prize amount, and usually very welcome. Yes, DTs has won a couple of times, thank you, but I've been giving serious consideration to having my name permanently removed from the drawings. Couple of reasons, really.

For instance, I can see where if this became a coveted honor or if the prize amount rose to be serious money the temptation to abuse would rise:

"There! The driver has started the engine and can't hear us. I just wanted to tell you, before we loaded you for transport he told me he wanted to kill you, but I talked him out of it. But," - here one would look sad - "I don't know how many more lives I can save from his diabolical, serial-killing hands. They're having budget cuts, and unless they get letters from patients... Anyway, don't look him directly in the eyes when we get you home. It angers him. My name is Steve, and I'm your friend."

So yes, perhaps it's best to keep the prize money low, and make sure patient praise plays no part in figuring annual raises.

Still, I have had partners who have pimped themselves to patients by hinting, heavily, that words of praise should go to this address, attention this person, or called in to this number during business hours Monday thru Friday - meaning not, "pick a day Monday thru Friday" but rather, "each day Monday thru Friday" - it tends to annoy me because it seems to me unprofessional.

Unprofessional, and I should add, extremely narrow-minded, as if we were the only ones to have provided any service to the patient when in fact we're a small part of their Illness du jour Adventure.

Let's take a very simple call: EMS is called to a nursing home for an elderly female, injury from a fall. The medics find that the patient became lightheaded on exertion and had a syncopal episode. They find junky lung sounds bilaterally but their heart monitor shows no acute processes. The patient states she's been having trouble breathing "because of a cold". Her O2 sats are in the mid to high 80's. The lead suspects O2 deprivation secondary to pneumonia as the primary cause of the patient's syncope. Due to the unwitnessed fall they err to caution and board and collar the patient even though there are no complaints of head, neck, or back pain.

(BTW, I was going to use either sockpuppet.gif or clown.gif, but, like Ray in Ghostbusters, chose something that could never, ever hurt us...)

So, EMS (0) (0) gets on scene and brings her to the ED nurse (0) who calls in the lab tech (0) to get blood to send to the lab (0). Portable x-ray is taken (0) of the patient's chest due to the pneumonia. The doc (0) orders a CT (0) to check her head, or perhaps even an MRI (0) to which the transporter (0) takes the patient. No traumatic injuries are noted, and a diagnosis of pneumonia is confirmed. The decision is made to treat with IV antibiotics for a day or so, and to observe. The patient is transported (0) to the floor where the floor charge nurse (0) takes ultimate charge of care. The day nurse (0) for this patient might have a tech (0) hang her bag and monitor the IV pump. Nutrition services will bring the patient lunch (0) and dinner (0). The night nurse (0) and night tech (0) will continue care. The same doc or perhaps a different doc (0) will examine the patient next day, declare her on the way to recovery and ready for discharge back to the nursing home. Our team arrives (0) (0) and transports the patient from the hospital.

I left out a lot of marshmallow sailors doing a lot of necessary jobs, and doing them well, but you get the point. It annoys hell out of me to have a partner say, "Hey, you remember that pneumonia we took out of Major Hospital? We didn't get a letter. I thought we were really nice. Some people, huh?"

Grrrr.

So, yeah - from now on DTs' name does not go in the hat. Instead, let me see the letter (they do that anyway) and find out what it is, specifically, the patient remembered and liked enough to take the trouble to write. I'll try and do that more often. If one month every patient was well enough served to make a recommendation, then perhaps I'll take that $20.


Tuesday, April 17 2007
Failed in the Field

Some days be just plain strange. Driving off from a residence:

*BLAM*

"What the hell was that?" asks DTs.

"I dunno, lemme check. Hey, we gotta huge honkin' hole in the rear tire!"

"Great"

Rear tires are "dualies", a set of two tires together, so we're drivable. We backroad it to the station, check out and switch over to another bambulance in time to take another call which requires the use of medication pumps. The patient is loaded and DTs plugs all his goodly toys in to use the "wall outlet" power in the box.

"Bee-lop!" says the pump. "Battery low!"

Not a problem, thinks DTs. "Hey driver, hit the inverter switch please."

"It's not up here. You got it back there."

"Um, mine's not working." The box has lights but no auxilliary power.

"Bee-lop!" says the pump.

"Shut up," mutters DTs, and adjusts the drips by hand.

Finished with that call, we again trade units. Our next patient is having chest pains and needs transport to a cath lab.

"Warning, Warning Will Robinson!" The heart monitor is going nuts.

"Wuzzup?" thinks DTs.

"Asystole! Asystole! ohmygodohmygodohmygod! AAAAAaaaaahhhh!" shouts the monitor as it begins pissing a stream of paper onto the bambulance floor. Meanwhile, the rhythm shown is a paced sinus rhythm, 80 bpm; since this patient has a pacemaker from a previous cardiac episode, that seems about normal. A quick check of all the leads shows them each attached to the patient.

"How're you feeling, ma'am?" asks DTs.

"Just fine!" chirps the patient. "What's that racket?"

"Uppity paperweight, ma'am," says DTs, turning it off.

Now, lest you get the wrong idea, I gotta say - of every service in NoVA (and we all see each other at the ambulance bays of facilities, etc.) mine has the very best of everything. EVERY ambulance is brand-new, almost every piece of equipment is brand-new as well as being top-of-the-line.

It was just one of those days, is all.


Sunday, April 08 2007
"RAT" - a Cologne for EMS

A typical BLS call involving a patient ready to be discharged from the ER. She had arrived via 911 with a chief complaint of "difficulty breathing" but was now in no distress. Since it was BLS, my partner was AIC on the call and got the full report from the nurse.

The patient had some other issues going on, was contracted in all extremities and immobile, non-verbal, but could speak well with her eyes, nod her head, and smiled largely at my jokes (a sure sign that something wasn't quite right.) The RN performed some quick "back of the throat" suction just before we loaded her. There were some secretion issues but nothing requiring hospitalization.

Uneventful transport, but the patient did require one suctioning during the five minute ride to the group home. Door-knocking and bell-ringing drove the home-care trolls from beneath their bridge to allow us ingress, and the patient was transferred to her bed without incident. DTs the Dutiful left the premises and took the cot outside for cleaning, clean the unit, etc., while the AIC gave report.

The AIC arrived about five minutes later. "Man," he said, "I'm calling Adult Protective Services."

"Whyzzat?" asks DTs. The placed looked okay, no bad odors - not the Ritz, but we've seen worse.

"They," replied his partner, "Do not have suction."

"Say WHAT?"

"No suction."

"But- that patient will probably need suctioning through the night!"

"Yeah, well, I didn't find out they didn't have it until I'd turned over the patient."

"Crap!" exclaimed DTs. Had we known, we could have returned the patient to the ER at the very least, or even stayed on scene until something was worked out. As it was, to take the patient now would be kidnapping; to stay on scene after the patient was no longer "ours" and care for her was way, way outside our scope of practice.

"Well, hell's bells." What to do, what to do?

In the end, we alerted APS and tried to get them to understand this was "stat", and returned to the releasing ER to notify the Charge Nurse that the patient would in all probability be coming back, and why - so they'd not release her again until the situation was fixed at the receiving end.

Odd thing about this is we're usually very, very proactive in checking on the destination. Patient is going home, but on O2? Has the O2 guy been to the home, is there equipment there, has the family been trained on it? I usually call and check before taking the patient from a facility. This one slipped by ol' DTs, but that's how we learn, I suppose.

Oh, and to the facilities which are, um, "inadequate": I definitely got no problem ratting you out. Get it together for your patients, please.


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Posted Friday, May 25 2007 13:08  Site Meter