I’m old and crusty, and I haven’t seen many emergency patients in the field over the past several years. Yes, I teach from the “Ivory Tower” — the university classroom perspective. Hence, I often have to watch helplessly as our students dismiss the pedantic old ways I preach in favor of the real world EMS and how “things are really done.” I’m trying to work on staying current by responding to calls in the field with our local EMS services, but there’s no getting around the aura of credibility of “real” paramedics who do the job every day.
In my sometimes futile attempts to impress upon my students the importance of doing things step-by-step and by-the-book, I can only hope that the message will get through to a few of them. It’s an important message, regardless of where you are in your EMS career — either as a new student who’s just learning, an experienced EMT or paramedic practicing in the field, or a salty old instructor, as I am. I hope to have the chance to reach just a few people today. Here’s the lesson.
That may be the way that they’re doing things in the field. Maybe they aren’t auscultating and palpating every chest, or doing a neurological check on every patient, or taking the time to examine for every possible injury or neurological deficit or deformity on every patient. Maybe they don’t ask every SAMPLE OPQRST SOAP question, maybe they aren’t transporting patients that don t need to be transported, and maybe, at times, the policies that state that the emergency medical control physician must be contacted for a consultation is just a rule that’s meant to be broken.
Maybe it’s so, but not always. It’s the times it isn’t so that I get the call. That’s right. When a patient dies, or is paralyzed, or has some other reason to complain about his patient care, valid or not, the lawyer gets a call. Then someone like me gets a call from the lawyer — asking for help.
That’s the way that they do it for real. It’s true. Sometimes the resource physician isn’t contacted, regardless of the rules. Sometimes the patient isn’t resuscitated, even if that’s what the field protocols say to do. Sometimes the chest doesn’t get auscultated, or the full body examined under the clothes, or a hundred other possible things that might have been done but weren’t. Then, it’s up to the crusty old paramedic to step up and make a case for the way things were done.
The way that they do things are almost always OK. It’s true, doing the full ACLS algorithm isn’t appropriate, and the medical control physician didn’t need to be called for a consultation, or the patient’s condition was obvious and auscultation of the chest was impossible because of the patient’s continual verbal complaining. And sometimes, just sometimes, the patient was completely uncooperative, making a complete and full assessment impossible. Sometimes that’s true enough. The important lesson to remember, though, is that even when all of that is true, the legal defense usually costs tens of thousands of dollars, and often much more. That is, it costs that much even when you win. So, what should you do to avoid this?
Always go through all the steps. Take a second set of vital signs on every patient and record them. Always auscultate every chest, and then document it, even if, for example, you couldn t hear the breath sounds adequately due to the patient’s continual talking and background noises. Always palpate the chest and abdomen, and check the patient’s back and range of motion of all extremities, even when it’s an obvious sprained ankle, and that’s all it is. Always, always, always ask about prior medical history, medications and allergies. And always, please go through the full assessment systematically, step-by-step. You’ll sleep better at night and save yourself and your organization a lot of grief in the long run.
The National Association of EMS Educators is a 501 ( c ) non profit educational association that has been incorporated since 1995. It is a professional membership organization that is made up of over 3,000 EMS educators, both nationally and internationally, that include Instructors, Program Directors, Deans, Training Officers, EMS Physicians, EMS Nurses and EMS State Officials. It is governed by a board of directors and the home office headquartered in Pittsburgh, PA. The mission of The National Association of EMS Educators is to inspire excellence in EMS education and lifelong learning.
