Recently, I had the opportunity to respond to some EMS calls with my local volunteer fire department that bring into question how we define and provide patient care. Our department is a small volunteer department covering 10 square miles, surrounded by two paid departments and a paid county EMS agency. We have an ALS first response engine and a dedicated group of volunteers.
The first call was for a “suicide attempt with major bleeding from the wrists.” It was a patient who had a history with our service and, upon arrival, we found she had fled the scene. After a short search by our department and the police, we found her in the woods a few hundred yards away from her house. It was nighttime, and the ground was moist, and she was shivering, barefoot and wearing only a thin top and jeans. The bleeding from the wrists was no more than scratches that were not actively bleeding.
After a quick assessment, the crew was ready to walk her out to the street to meet the ambulance. I protested, concerned she would hurt her bare feet on the rough ground in the cold weather. One of the responders replied, “She got herself into this,” and stared at me as if I were crazy.
Fortunately, someone radioed for the ambulance to come and pick up the patient. As the ambulance pulled up, I met the crew and asked for a blanket for the patient. The crew didn’t have any. We used two sheets to bundle her up, and placed her on the stretcher.
The second call was for an elderly woman with chest pain. It appeared to be cardiac, so our team administered oxygen, aspirin, nitroglycerine and performed an ECG. The nitro reduced her pain from a 9 to a 6. When the transporting crew arrived, they placed the stretcher in the hallway, since the bedroom was cramped, and asked the woman to stand up and walk to the stretcher. I again protested and asked to carry her to the stretcher. I was ignored, and the woman was walked.
My venture in EMS started in 1979 after watching too many episodes of Emergency. As an adventurous 16-year-old, I found a volunteer EMS service that would accept a teenager and began my lifelong career in EMS. Shortly after, I enrolled in a basic EMT program, and then a paramedic program. One of my mentors in those early days was a woman named Ginny Bakas, one of the few certified EMTs at our service.
While I was interested in the science of medical care, Ginny made sure I understood the social aspect of EMS. She would evaluate me on how I spoke to the patient, whether I was able to carry on a conversation during the entire ambulance ride to the hospital, my interaction with family members, as well as the medicine of emergency medical care. She reminded me that social interaction is an important part of our medical interactions.
I later went to work for the City of Pittsburgh, a high-volume urban EMS system, and certainly had my share of cynical moments—the frequent flyers, the BS runs, the people in “chronic” pain. I was losing my compassion. I moved on to become an EMS and rescue supervisor with a progressive suburban agency, but my bad habits didn’t change.
I guess my moment of awakening was when my mother was diagnosed with cancer. That’s when I began to see the social side of this disease, and it reminded me of the lessons taught to me by Ginny. A cancer patient in pain was no longer a frequent flyer or BS call, but rather an opportunity to provide a meaningful intervention. I felt like an idiot for all of the times I ignored those lessons on compassion and social interaction.
Paramedic students today receive so much more training than the measly 150 hours required for my certification. But something that appears to be lacking are those wise lessons taught to me as a teenager. Patient care is about the patient. Whether you like them or not, sympathize with them or not, or are upset that they called you at 2 a.m. because they couldn’t pee, or weigh 400 lbs and climbed upstairs before calling 9-1-1, our treatment needs to be much more than IVs and splints. The social part of patient interaction is not something that you can learn from a textbook. It needs to come from our instructors, preceptors and co-workers. Maybe we should take a lesson from Ginny Bakas, and evaluate our EMS students not just for the number of runs, splints, blood pressures or intubations they perform, but whether they able to carry on a conversation with the patient during the ride to the hospital, or how they interacted with the family.
Thank you Ginny, for giving me such an important lesson in emergency medical care.