To Walk or Not To Walk?

The Happy Medic (THM) recently posted a fantastic topic on his blog. I love diving into controversial decisions that we have to make every shift. Here’s one of those questions that we need to answer on just about every call. Should we walk the patient to the pram or carry them?

This is one of those things that we have no choice but to address in every system on just about every call. How to we get the patient to the pram? When is it OK to walk them?

It seems like this subject got rolling on Justin’s (THM) blog when EMS types from around the country started sending him feedback about his role in the documentary film, The Chronicles of EMS. He was surprised by the volume of comments about him choosing to walk patients to the ambulance.

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Credibility and Redundancy

I’m going to make an important point and I need you to pay attention. That sentence, the one I just wrote. The one about saying something important. That was a redundant statement. And it undermined your sense of my credibility as a blogger and an EMS educator. No really, it did.

Not in a huge way. Not like if I had said something that you knew to be completely false, or got all wishy-washy, namby-pamby about some critical issue regarding your patient care. But it made you doubt my sincerity just a little. Somewhere in your subconscious you thought, “If it’s important, why not just say it?” You questioned why I felt the need to preface my important thought with a statement declaring my own thought important.

It’s as if I doubted my own credibility.

So why shouldn’t you doubt it too.

Right?

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Don’t Be A Jerk

I didn’t draw the graph at right. It was made by a woman named Jessica Hagy over at www.thisisindexed.com. Jessica is not in the medical profession. She draws her observations about the world on index cards and posts them online.

She also has a long and growing list of blogging awards from around the world. Mostly due to her brilliantly irreverent style and her ability to make social observations that resonate with people.

Like this one.

It’s a sad but true observation. For some reason, it seems like many medical personnel have an interesting combination of helpfulness and jerkiness. Why do you suppose that is? I’ve thought a lot about that over the years.

I think a friend of mine, Steve Brien put it best when he said, “Some of us still have a lot of us still in us.”

Our profession is about the patient. It’s not about us. Remembering that simple fact, and keeping it at the forefront of our thoughts, isn’t as easy as it might seem.

Don’t Forget To Ask The Patient

Let the young know they will never find a more interesting, more instructive book than the patient himself. ~Giorgio Baglivi

It was nearly two decades ago that I knelt on the floor before Sammy in the Santa Clara County Sheriffs booking facility. I remember him so vividly that it’s hard to believe so much time has passed. There was nothing exceptional about him. Handcuffed to the waiting area bench, he looked very much like you might expect a man high on drugs, being booked for petty larceny, might look.

Sammy felt like his heart was racing and, given his drug history, the officer thought that he needed a once-over before heading off to the county lock-up. I, the young, scared, mostly clueless paramedic intern was doing my best to evaluate him. Growing up in a quaint California suburb I hadn’t crossed paths with to many folks like Sammy. He, quite frankly, terrified me. My preceptors stood back and observed.

“Sammy did you do any drugs tonight?” I asked.

“Yeah, I did a speedball about an hour ago.” He casually offered.

I looked over at my preceptor Mark hoping for clarification. I got nothing. I looked back at Sammy and then again at Mark who smiled demurely. “What’s a speedball I asked?” Mark knew the answer but he had other ideas. He gestured toward Sammy. “Ask him. He’s the one who took it.”

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The Ultimate EMS Protocol

I don’t handle the card much anymore. It stays inside a plastic sleeve in my planner. The edges are worn and the words are faded. It wasn’t printed on kind of paper that travels well in a wallet for twenty plus years. But it’s been worth carrying. It is, quite simply, the ultimate EMS protocol.

I don’t read it often. I’ve read it enough times over the past two decades to have it pretty well memorized. It’s my STAR CARE card.

I got it back when I was a paramedic student at Baystar Ambulance in San Mateo California. It was 1992. I always believed the original author was none-other-than EMS guru Mike Taigman. Mike had signed on to be the quality care guy at the fledgling service and I knew the cards had originated in his office.

The idea was simple. We can’t write a policy for eveything you may encounter in the field. Instead, use this guideline. If the decision you’re about to make passes these eight tests, we support you. NO matter what. Come hell or high water … we have your back.

It’s brilliant really. It’s the policy to end all policies. It’s the grand daddy algorithm. It’s the ultimate protocol.

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Patient Rapport Land Mines

Patient rapport is something we can easily overlook in our quest for better medicine. Our book never touched on it. It was barely mentioned in class. It doesn’t make its way to the EMS conference circuit very often – outside of a few exceptional lectures by Thom Dick. So how important could it possibly be to good patient care?

Patient rapport is one of those foundational skills in EMS. When we improve this one skill, it supports everything else we do. You’ve heard me talk about ways to break through the initial patient / caregiver barrier and develop rapport in the past. Now let me talk about the other side of the coin.

Let’s discuss the things that we do that break down rapport or prevent it from ever forming. It’s much easier to break down rapport than to build it up. Here are some of the landmines that can break a good rapport into bits. We’ve all stepped on these a few times in the past and, unfortunately we’ll probably do it again. The best thing we can do is recognize these awful habits for what they are and try to avoid them at all costs.

Here are my top six patient rapport killers:

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What Is The Good Samaritan Law?

The term “Good Samaritan” comes from the gospel of Luke. In the parable told by Christ, a Samaritan helped a Jew who had been beaten and robbed. At the time, the Samaritans and Jews were mortal enemies. Through the parable, Jesus attempts to redefine what it means to be a good neighbor.

Reading some recent conversations on the good Samaritan law in a few online forums, I’m reminded not of the biblical parable, but of the parable of the six blind men describing an elephant. Remember that one? One guy feels the side and thinks an elephant is like a wall, the other feels the tail and thinks an elephant is like to a rope? Initiating a discussion on the good Samaritan law in an online forum of EMTs is an invitation for confusion and scorn.

“It only applies to bystanders.”

“No it doesn’t! It only applies to EMS personnel.”

“And only if you’re off duty. Unless you’re a volunteer. And then only … no … wait.” And on and on.

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Patients Don’t Buy Backboards

I have a Labrador named Eddie (pictured below). He eats only Eukanuba dog food. That’s because we buy it for him. If we bought him a different brand, I’m sure he would eat that as well. He might need to get a little hungry before he agreed to the switch, but my gut tells me that he would eventually concede.

Knowing my dog, probably sooner than later.

I want to quote from the Eukanuba web site:

Satisfy your dog’s taste buds with the succulent flavors of beef and rice. Your dog is sure to enjoy every bite with real beef as a key ingredient.

Reading this, one thing is clear. Dogs don’t by dog food. This product was clearly not formulated for dogs and it isn’t marketed to dogs. This product is designed to make people feel good about what they’re feeding their dogs. If dog food was made for dogs it would be cat flavored or rodent flavored or bird flavored … or maybe even other dogs butt flavored. My dog doesn’t care about succulent beef and rice. He cares about feeling full. Nobody is going to convince me that rice tastes succulent to a dog.

So what about backboards? Patients don’t buy the backboards they ride to the hospital on do they? Patients are the end users of the product, but EMS organizations make the decision which backboards to buy. It stands to reason that the backboards are probably designed more for the people who buy them than the people who use them.

You see where I’m going with this right?

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Connections

Sure you communicate with your patient, but do you make connections? The difference may sound like semantics … but it’s not. The difference is extraordinary.

Do you remember James Burke? He was the plucky, dry humored narrator of the 1970s BBC TV series “Connections”.  James would begin each episode with some historical event like the invention of the catapult and show how it was related to the way we make billiard balls or some other impossible sounding connection. His message was simple and profound. The big idea was that we are interconnected in ways that are complex and impossible to predict. Reality doesn’t flow forward in a perfect linear timeline.  An intricate web of human connections drive history and innovation forward.

Without one minor connection another crucial event becomes impossible. Alter one seemingly insignificant event and you change the course of history.

There is something vital in the way we are interconnected. When we connect, we change each other in ways that we can’t predict. If we simply communicate with our patients and coworkers but never reach out across that gap and connect with them, our work can become dull and routine. On the other side of the gap the patient / caregiver / human relationship is far more fulfilling.

If that sounds worthwhile, let me give you a few tips for making conscious connections with your patient.

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Are you the opening act or the rock star?

Let’s not beat around the bush about this. You’re going to need to make a decision about who you want to be in EMS. If you’ve decided to be in EMS you can’t avoid it. Take a moment and decide.

Are you the opening act,

               or are you the rock star?

You’re either one or the other. People will call. You’ll show up. And when you do, you’ll either be the opening act for the real medical care they’ll receive later, or you’ll be the rock star. The first medical professional to evaluate them and begin the course of their medical treatment and care.

It’s up to you.

The opening act shows up and tries to keep everything stable until the big players are ready to come on stage. They try not to get booed and keep everyone moderately entertained. They’re a small player at a big show and when they stand in font of the crowed, they feel it. They are happy just to be associated with the rock stars.

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