Columns, Patient Care

Patient Care Diminishes When Patients are Perceived Negatively

Issue 10 and Volume 41.

“Dispatch, you can show Medic 3 on scene.” There had been no calls up to that point-that point being 14 hours into my 1,440 minute shift and predictably, I was toned out just as I was crawling into bed. My monotone voice announcing my rig’s arrival had a hint of articulated whimper with just a slight dash of disdain added on the distal consonant for attitudinal effect.

I was tired. More importantly, my adrenals were tired-tired of being on standby mode for so long with nothing to show for it. Then again, I should know better. It was, after all, that magic hour when a few selected ETOH (Extremely Trashed Or Hammered) nomadic gamblers, for whatever reason, become more energetically mobile and inevitably undergo an AGA (Acute Gravity Attack) resulting in a FIRT (Failed Impact Resistant Test) from the surface of the planet earth.

It was a classic display of what I anticipated seeing: a 50-something female sitting in the middle of a back alley behind a casino attempting to grab the road’s asphalt to keep it from spinning off the earth’s axis. The heavy smell of alcohol and slurred speech from the patient confirmed my preconceived expectations. As the firefighters cleared her C-spine the patient mumbled, “I’m fine. I only had three glasses of wine. I’m not hurting anywhere. I just want to go home.” Indeed, there were no signs of obvious trauma and patient seemed aware of her surroundings, including the five EMS providers and firefighters she saw standing around her. OK, there were four of us, but one of the EMTs was the size of two, so … close enough.

Witnesses state she didn’t fall, but was helped slowly to the ground. I turned to my partner and with a sarcastic smile. “You’re on deck to tech.”

Obviously at this point I could foresee this wasn’t going to be an ALS call and, if we were really lucky, once all the medical clearance formalities were followed, she may not even have to go to the hospital-if we can find a friend or family member to care for her. Thinking out loud and with a sarcastic smile, I blurted, “At worst, we can have her transported to detox by our local police department.” The officer didn’t smile back.

Visions of my head making a soft landing on my bed began as my fellow crew members progressively yelled out their patient findings. “C-spine clear … glucose reading within normal limits … no past medical history … no shortness of breath, chest or abdominal pain … negative history of nausea, vomiting or diarrhea … Negative headache or blurred vision … patient neurovascularly intact distally …

Now for the real test: Can the patient ambulate independently with stable vital signs? The suspense was killing me-Yes … Yes!! … %@#&!! Goodbye my sweet pillow. For on this night it was not meant to be. Sniff.

As we loaded the patient into the ambulance, I asked an EMT if he wanted to establish the IV, seeing as he hadn’t started one in a while. I told him she had great veins and that there was no way he could miss. He missed.

The fact that the IV was squandered didn’t bother me so much as did the peculiar angle the arm was now lying once the IV tourniquet was removed. “Are you double-jointed?” I asked the patient as I moved toward her. “No. Why?” she inquired back.

As I grabbed her left elbow and shoulder I could feel crepitus and deformity in her mid-shaft humerus. “My God!” I announced for all to hear. “You broke your arm!” The patient slowly turned in the direction of her arm. “Really? Huh! Do I still have to go to the hospital?”

Nobody pointed any fingers at anybody for missing the fracture. We all blew it. We took shortcuts. It didn’t matter that the patient didn’t have any pain or was even aware something was wrong with her arm. The bottom line is we let our negative perception of the intoxicated patient project our patient care despite the many years of experience between us providing what I consider high-quality prehospital care.

I get it. It happens. We’re human and nothing can wear you out like caring about other people, but the bottom line remains: Our perception is our reality, and in EMS those realities can often become perceived as negative labels. Once you label a patient, you negate them. When we alter our perception, we’re open to positively altering our care. Don’t believe everything you think-including easy IV sticks.