Patients Define Their Emergencies (Part 2)

True Story…

The dispatch information was updated before we had even rolled our rig out onto the pad. Eye injury, no serious symptoms. Jodie shut down the lights and I informed dispatch that we’d be responding non-emergent.

Up stairs and inside the small two bedroom apartment, Samantha, our patient, was waiting on the couch, holding a hot compress to her swollen right eyelid. Mom worked calmly in the kitchen finishing diner for her other two children. Alan, Samantha’s father sat on the edge of his seat next to his daughter in a state of barely containable anxiety.

He had recently arrived home from work and his wife had informed him of the apparent infection in Samantha’s right eye. One look and he was on the phone to us. Now he breathed rapidly as he fumbled through a list of questions. What caused it? Could it damage her vision? Could she lose her eye? Could she go blind?

I cleared the engine to go back in service and sat down next to him. Over the next ten minutes we both explained what pink-eye was and how to take care of it. We talked about hot-compresses and how contagious the bacteria was going to be. We reviewed the typical course for such and infection. How to prevent it in the other kids. How likely it was that one of them already had it. And we discussed his plan for morning. (It involved asking a neighbor to drive them to a near-by clinic.)

Alan called 911 for pink-eye. And…(This part is bound to be controversial, depending on what kind of system you work in.) I never offered to take him to the emergency room. And he never asked.

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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 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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Get Anyone to Go With You to The Hospital

I’m going to share with you a very powerful technique to convince just about anyone to go with you to the hospital, and I’m going to ask a favor of you. Please only use this technique in the patient’s best interest. This isn’t a technique to drag out when your service pressures you to increase transports or you’re not in the mood to call in for a proper refusal. This is a technique for when you really honestly believe that the patient needs to go, but they refuse.    -Steve

It’s an interesting contradiction in prehospital medicine. The people who don’t really need an ambulance insist on transport and the really sick folks refuse to go. Sometimes the people we could really help dig in their heals and just refuse to go. It’s frustrating. It can be maddening. And occasionally it means that we have to pull out our paper work and sign a potentially really sick patient out against medical advice. (AMA)

In these moments we implore the patient to reconsider, hand over the paperwork for signing and then we say something about calling us back if things change. Now let me give you one more technique to try before you pack up and walk away.

This is a simple, three-part technique. 

Step One: Establish a rapport with the patient. Hopefully you’ve been working on this from your first contact. Fair warning, don’t try to skip over this step. If you haven’t established a rapport with the patient this just isn’t going to work. The patient needs to trust you and be willing to consider what you say.

If you’re developing your patient rapport skills I recommend reviewing Connections, Patient Rapport Land Mines and You Can’t Give Away What You Don’t Have. You may even want to stop by Patient’s Define Their Emergencies.

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Before We Met

A letter from your patient.

Dear emergency medical technician,

I know we didn’t get along so great the other day when we met each other. I want to apologize for that. It was partially my fault. I admit it. I wasn’t the easiest person to get along with and I could see it frustrated you. By the time we reached the hospital I was pretty frustrated myself.

I just want you to know that I’m not always like that. You met me at one of the worst moments of my life. You probably experience stuff like that all the time. I could see that none of what was happening was much of a big deal to you. But I’ve never been quite so scared, I don’t remember feeling pain like that before.

Keep in mind that I was many different things before I was your patient.

Long before we met, I was a mother of four children, three of whom still stay in regular contact. I have nine grandchildren. My youngest grandchild loves my spaghetti. She usually won’t eat spaghetti, but something about the way I make the sauce is perfect for her. Cooking for my grandkids gives me a special joy. While you were splinting my leg I kept wondering how long it would be before I could stand in front of my stove again. When your my age, healing can take a long time.

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