It’s Critical to Seek, Synthesize & Incorporate All Available Patient Information - Administration and Leadership - @

It’s Critical to Seek, Synthesize & Incorporate All Available Patient Information


A.J. Heightman, MPA, EMT-P | From the April 2014 Issue | Wednesday, March 26, 2014

Imagine going on multiple calls with limited dispatch information. When you arrive at the scene and approach the family to obtain important incident history, mechanism of injury or patient information, you’re told rather bluntly, “We already gave that information to your dispatcher. We’re not repeating it to you!”

You might not be too fazed by that type of response if the patient wasn’t critical or unconscious and had the ability to speak to you. But, if the patient was unable to provide important information—like chief complaint, onset of symptoms or medications—it’s the type of communication gap that could hamper your ability to provide proper treatment and could result in the patient’s deterioration or demise.

And, how would you feel if every time you worked hard to perform your job, document your assessment and convey a concise report to the receiving hospital staff on ED arrival, a staffer said: “No need to tell us anything, we’ll ask them our own questions and do our own assessment”? I’ll bet you’d be frustrated—if not furious.

Why? Because it’s not only medically sound and important to seek, synthesize and incorporate all available information when treating a patient, it’s also common courtesy to respect the training, expertise, first-hand knowledge and clarifying details provided by first responders, off-duty medical personnel or family members.

The failure to obtain or accept information from all people first on scene has been an issue that frequently surfaces and needs to be addressed by educators, preceptors and EMS leaders to make sure information is embraced rather than ignored.

I’m talking about when you or I are off duty, come across a person in need and jump in to care for them before the official responders arrive on scene.

I personally can’t drive past a “person down” on a street or sidewalk without stopping to assist them. I not only would want off-duty, well-trained personnel to do that for my loved ones, but I wouldn’t be able to sleep if I thought I drove by a bleeding or choking child who died because I didn’t give them a few minutes of my time and expertise.

Most dedicated responders are never off duty. They’re always game to pitch in at a mass casualty incident or other emergency scene. I carry BLS supplies and assessment equipment in my vehicle to take care of friends who need help or to treat myself when I fall out of trees. (Don’t ask!)

Recently, I had two back-to-back days when I happened across incidents and stopped to render “pre-responder arrival” care. At the first incident, a T-bone collision on a busy San Diego roadway, I did an assessment and rendered care, and my information was accepted professionally by the arriving San Diego Fire Rescue and Rural/Metro ambulance crews.

I identified myself as an off-duty paramedic, told them all I knew and what I did for the patient, handed them a completed triage tag with all pertinent information, and left the scene.

The next day, my wife and I came upon a group of bicyclists surrounding one who crashed and fell. She wasn’t unconscious, never was unconscious according to the group, and really only had superficial wounds and hip pain.

A physician who had also stopped assisted me as I assessed her, and I had someone scribe all pertinent information about the patient.

The first-arriving ALS engine crew professionally accepted our findings and documentation. However, when the ambulance crew arrived on scene, the senior person on the rig walked over (with her hands in her pockets), blew me off when I tried to present information to her and proceeded to tell the young woman on the ground, prior to any assessment on her part, “You’re going to the hospital because you were unconscious!”

I looked at her, asked her where she got that information (presuming it was probably from the initial dispatch report) and told her the patient was never unconscious.

Without acknowledging me—or conducting her own assessment—she and her partner proceeded to place a backboard on the ground and slide the patient (who was comfortable resting on her side with the sore hip) onto it.

After that unsuccessful encounter with poor communication skills, bad assessment skills and inappropriate assumptions by this EMS-er, I sent an email to the senior manager of her service, who’s a good friend of mine. I told him I didn’t want her disciplined but, rather, felt she needed to be educated about her poor attitude, lack of respect for other medically trained responders on the scene, “assumptive transport decision” and lack of proper assessment prior to movement or transport.

He responded immediately and told me a supervisor would meet with her to provide several teaching points.

Remember that it could be you or a loved one lying on the pavement for precious minutes someday before the official responders arrive on scene.

Gather and filter all available information presented to you by all sources present. Most importantly, respect and use the services of dedicated responders who take the time to stop and care for patients before they truly are your patients.

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Administration and Leadership

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Related Topics: Administration and Leadership, Leadership and Professionalism, patient history, off-duty, information, communication, Jems From the Editor

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A.J. Heightman, MPA, EMT-P

JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P, has a background as an EMS director and EMS operations director. He specializes in MCI management.


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