Peter Canning, at
Street Watch: Notes of a Paramedic, writes
The Grapes of Wrath. He describes a call where he did a lot to accommodate a family with more belongings and family members than could easily be managed, either by EMS or by themselves. It is a good post about problem solving. In the comments Peter finishes up with:
My point in writing this is that so much of what we do in EMS doesn't really relate to health care. It's figuring out a way to manage life. I get annoyed a lot by patient demands (turn off house lights, get their coat or reading glasses, put some water out for the dog, call their hairdresser and tell them they won't be making their appointment. When I look at it, it isn't such an imposition to help people.
Not liking the patient demands is understandable. It doesn't feel like EMS, but as you mention, much of what we do is not medical.
For the patient who will not be getting Mr. Toad's Wild Ride, I prefer to ask how things should be left or if they need anything else. We have been asked to come into the patient's home on one of the worst days of their life (unless this is someone who always calls). I should try to leave things as I found them, as much as possible.
Turning out the lights. Some people worry about their electric bill and putting their mind at ease allows us to get the patient to relax a bit more. An agitated patient is not good. A patient who is agitated, not because of something that was going on before we got there, but because of how we acted, is not good. Unless the patient has depressed vital signs to begin with, we are probably making the vital signs worse by agitating the patient.
Get their coat. I never wear a coat, unless I am outside for an extended period, but I understand that other people feel the cold more than I do. The patient might not be able to get someone to show up with something warm to wear to bring them home. If they will be taking the bus or a taxi home, even if the police will be giving them a ride home, there may not be the possibility of providing warm clothing.
Get their reading glasses. I almost always ask if they want to bring something to read. I try to keep some reading material with me all of the time. Otherwise, I would never get much reading done. As it is, most of my reading is done on line. Most books are small and light and, if they are nearing the end of the book, bringing a second book is not much of an imposition. The patient will probably be in the hospital for enough time to make more than a dent in
Remembrance of Things Past,
Moby Dick, or even The Grapes of Wrath. Books that are more often read as Cliff's Notes, than in the full text. Ike at
BookScoutLookOut, his books/running/EMS blog, has been reading Remembrance of Things Past and sharing quotes at his site. There are several sites with free downloads, that include many audio books, some of them are children's books and may help to keep them from wandering or causing trouble. As a parent, if you are not able to read to your child every night, maybe having an audio book to read them to sleep is an alternative. Travelling by car, it is a good idea, as well.
LibriVox.org has a lot of free download audio books. If you are not home to read to your child at night, you can always read to them during the day. If you want them to do well in school, there is no better preparation than spending time reading to your child. If you can't figure out what to read to them, maybe you could read this blog to your child, or maybe not. :-)
Make sure a pet is OK. If the patient is going to be in the hospital for a while, the pet might not be able to fend for himself. If the patient has been sick for a while, the pet might already be in a state of neglect. I have had a patient call 911 out of more concern for a pet, than for himself. Service dogs should accompany the patient. They may not respond well to lights and sirens and being thrown around, but nobody does and we should be avoiding that, anyway. Pets are family to some, toys to others. We should treat them as if they are family members. Some family members need to be controlled by the patient. Some family members are helpful. Family members usually do not bite unless you antagonize them, but a bunch of people showing up with lights and sirens may be antagonizing.
Call the hairdresser to cancel an appointment. I usually hand them my cellular phone to cancel appointments, but few do not have their own cellular phone, so this is rare. I have talked with a judge, a teacher, employers, parents, spouses, and others to explain where we are going and what is going on - after obtaining permission from the patient. Sometimes they only give limited permission (for example, you can tell them where I am going, but not what kind of medical emergency). No hairdressers, yet.
No. We are not there as a concierge service, but that doesn't mean that it is wrong for us to attend to the patient's needs. The question is, "What is reasonable?"
When it comes to unstable patients, some judgment needs to come into play. My preceptor's regular partner had a CHF patient insisting on getting dressed before going to the ED. The patient never did get fully dressed before he coded. How forceful was this medic? I don't know, but he knows how and when to be intimidating. How hypoxic was the patient? I don't know.
I had a CHF patient who was in the bathroom putting on makeup and refusing to come out. We could not justify breaking down the door with an oriented and responsive person on the other side. When we finally did get her to come out, we could see that she had been putting on makeup to try to cover her hypoxia. Fully alert and oriented. 90+ years old. More worried about her appearance. Aggh!
When we can, we should return everything to the way it was before we arrived. If we move a big table to get a stretcher in, we should try to move it back. It usually only takes a few extra seconds, when you have a bunch of people there. If the patient comes home and tries to move it, they may hurt themselves or just be unsuccessful. I'm not talking about a feng shui ritual here, but just putting things as close to where they were as is reasonable. Since I have been very critical of the lack of EMS critical judgment, or the lack of trust in EMS critical judgment, this is one place to demonstrate it.
These are not things that are outside of our scope of practice. If we moved something to begin with, we should move it back, as long as it does not interfere with patient care. The same is true for a medic in the back of the ambulance. You usually have time to clean up after yourself. It should be rare that your partner, or the BLS squad, has to clean up your mess. This is just good manners. Something we should be good at. Something we should be passing on to our children.
Anyway, the links to the free online books are:
eBooks @The University of AdelaideThe OnLine Books Page at UPennProject GutenbergLibriVox.org If you go to your local library and get a library card, often that will allow you to download current copyright protected audio books. These downloads have a limited life (a couple of weeks) before they are no longer useful - not like the audio tapes from
Mission Impossible that would burn up when played.
.
Not liking the patient demands is understandable. It doesn't feel like EMS, but as you mention, much of what we do is not medical.
For the patient who will not be getting Mr. Toad's Wild Ride, I prefer to ask how things should be left or if they need anything else. We have been asked to come into the patient's home on one of the worst days of their life (unless this is someone who always calls). I should try to leave things as I found them, as much as possible.
Turning out the lights. Some people worry about their electric bill and putting their mind at ease allows us to get the patient to relax a bit more. An agitated patient is not good. A patient who is agitated, not because of something that was going on before we got there, but because of how we acted, is not good. Unless the patient has depressed vital signs to begin with, we are probably making the vital signs worse by agitating the patient.
Get their coat. I never wear a coat, unless I am outside for an extended period, but I understand that other people feel the cold more than I do. The patient might not be able to get someone to show up with something warm to wear to bring them home. If they will be taking the bus or a taxi home, even if the police will be giving them a ride home, there may not be the possibility of providing warm clothing.
Get their reading glasses. I almost always ask if they want to bring something to read. I try to keep some reading material with me all of the time. Otherwise, I would never get much reading done. As it is, most of my reading is done on line. Most books are small and light and, if they are nearing the end of the book, bringing a second book is not much of an imposition. The patient will probably be in the hospital for enough time to make more than a dent in Remembrance of Things Past, Moby Dick, or even The Grapes of Wrath. Books that are more often read as Cliff's Notes, than in the full text. Ike at BookScoutLookOut, his books/running/EMS blog, has been reading Remembrance of Things Past and sharing quotes at his site. There are several sites with free downloads, that include many audio books, some of them are children's books and may help to keep them from wandering or causing trouble. As a parent, if you are not able to read to your child every night, maybe having an audio book to read them to sleep is an alternative. Travelling by car, it is a good idea, as well. LibriVox.org has a lot of free download audio books. If you are not home to read to your child at night, you can always read to them during the day. If you want them to do well in school, there is no better preparation than spending time reading to your child. If you can't figure out what to read to them, maybe you could read this blog to your child, or maybe not. :-)
Make sure a pet is OK. If the patient is going to be in the hospital for a while, the pet might not be able to fend for himself. If the patient has been sick for a while, the pet might already be in a state of neglect. I have had a patient call 911 out of more concern for a pet, than for himself. Service dogs should accompany the patient. They may not respond well to lights and sirens and being thrown around, but nobody does and we should be avoiding that, anyway. Pets are family to some, toys to others. We should treat them as if they are family members. Some family members need to be controlled by the patient. Some family members are helpful. Family members usually do not bite unless you antagonize them, but a bunch of people showing up with lights and sirens may be antagonizing.
Call the hairdresser to cancel an appointment. I usually hand them my cellular phone to cancel appointments, but few do not have their own cellular phone, so this is rare. I have talked with a judge, a teacher, employers, parents, spouses, and others to explain where we are going and what is going on - after obtaining permission from the patient. Sometimes they only give limited permission (for example, you can tell them where I am going, but not what kind of medical emergency). No hairdressers, yet.
No. We are not there as a concierge service, but that doesn't mean that it is wrong for us to attend to the patient's needs. The question is, "What is reasonable?"
When it comes to unstable patients, some judgment needs to come into play. My preceptor's regular partner had a CHF patient insisting on getting dressed before going to the ED. The patient never did get fully dressed before he coded. How forceful was this medic? I don't know, but he knows how and when to be intimidating. How hypoxic was the patient? I don't know.
I had a CHF patient who was in the bathroom putting on makeup and refusing to come out. We could not justify breaking down the door with an oriented and responsive person on the other side. When we finally did get her to come out, we could see that she had been putting on makeup to try to cover her hypoxia. Fully alert and oriented. 90+ years old. More worried about her appearance. Aggh!
When we can, we should return everything to the way it was before we arrived. If we move a big table to get a stretcher in, we should try to move it back. It usually only takes a few extra seconds, when you have a bunch of people there. If the patient comes home and tries to move it, they may hurt themselves or just be unsuccessful. I'm not talking about a feng shui ritual here, but just putting things as close to where they were as is reasonable. Since I have been very critical of the lack of EMS critical judgment, or the lack of trust in EMS critical judgment, this is one place to demonstrate it.
These are not things that are outside of our scope of practice. If we moved something to begin with, we should move it back, as long as it does not interfere with patient care. The same is true for a medic in the back of the ambulance. You usually have time to clean up after yourself. It should be rare that your partner, or the BLS squad, has to clean up your mess. This is just good manners. Something we should be good at. Something we should be passing on to our children.
Anyway, the links to the free online books are:
eBooks @The University of Adelaide
The OnLine Books Page at UPenn
Project Gutenberg
LibriVox.org
If you go to your local library and get a library card, often that will allow you to download current copyright protected audio books. These downloads have a limited life (a couple of weeks) before they are no longer useful - not like the audio tapes from Mission Impossible that would burn up when played.
.