You Define, We Whine...

Well, I felt like it was time for a rhyme. Or as a colleague put it:

I'm a poet

and I don't even know it

- ~ - Finish Interlude - ~ -

Taking my last few posts further, here's my take on Steve Whiteheads comment (from the ever great EMT Spot):

Quote #1:

I think the idea that people call 911 out of ignorance is a flawed analysis. People call 911 inappropriately for two reasons. 

1.) They have reached the end of their problem solving capability and need help. They don’t care if they are misusing the system. They care about getting help because they don’t know what to do. In their mind, that is an emergency. 

2.) They are purposefully abusing the system for personal gain. Whether it is for controlled medications, in-home health care, a ride to somewhere closer to the hospital, attention, a warm bed or food, they want something that we provide and they don’t care if they have to game the system to get it.

I believe there is a group in between, 1.5 so to say: People who undeniably need help. They need advice. They need someone, but not us. They just don't know that yet.

Our Comms/Control/Dispatch should control and filter these calls out, and divert them to appropriate resources (paramedic practitioner, hospital at home, telephone advice, GP, psych services, talking clock.)

And as pointed out on my last post, it would help for all health professionals to work together, know what to expect from each other, and know how to use the other agencies resources appropriately. A great step forward for paramedicine would be to be recognised as a profession (registration in Australia, hint hint.)

Quote #2:

Notice something about both of these types of people. They both have a basic understanding of the 911 system. Educating them further on the appropriate use of 911 will not prevent their next call. Even if you could stop them from calling, their problems are so common that their will almost certainly be a new person to call tomorrow instead of them. And the process begins again.

As I stated above, education for caller type 1.5 will help. You can do your bit, it won't change the world, but we gotta work on it together. Sure the big changes have to occur on a management level, but we're the road warriors actually talking face to face to the people.

So in a way, we're all asking for the same thing: More options, or tools as Steve calls them. The bottom line remains: Our current model of 'send an ambulance out for everything and treat at ED/ER/A+E' is outdated (and too costly).

Apart from those minor points I don't agree with, a brilliant (I really mean brilliant) post by Steve.

I just wish more of our breed would adopt such attitudes.

Something for the locals...

ACAP and Royal Perth Hospital are teaming up together again for this years 


Western Australian Trauma Symposium 


on the 


6th of November 2010.


Registrations are open now, earlybird closes on 30th September.

Dr Tony Smith, the Medical Director for St John Ambulance New Zealand, will be the keynote speaker.

Topics include Prehospital, Military and Rural Trauma Management, the aftermath of Disaster Management and Issues pertaining to Trauma Training

For more info go to the ACAP website:
http://www.acap.org.au/news/wa/wa-state-trauma-symposium/

Alternatives, pt II

Something I didn't consider in my previous post was the incompetence and lack of knowledge / laziness of other health professionals.

We picked up a bloke the other day who had been seen by his GP for an ongoing chest infection. The prescribed drugs weren't kicking in, so a couple of days and a few more visits later our patient is sent home again with no new treatment.
The patient calls the surgery again, stating the not improving condition, and wants to make another appointment.

The reply from the other end of the phone line? Call an ambulance, and go to hospital.

After all, we still are DFAs.

Someone loves me!

Thanks to the people over at Medical Assistent.net for featuring this blog in their top 50 EMS blogs.
Looks like a bit of a generic site design wise, but hey, some random number generator picked me, so I feel good :-)

Service

I recently ordered a sandwich at a cafe. Nothing fancy, but the waiter was friendly.
Halfway through my meal, some of the staff slowly started packing together the outside furniture. The waiter must have realized that I (unintentionally) was speeding up with eating, and reassured that there was no hurry, and I should take my time.

The best part came when I asked what time they close: "it doesn't matter. You take your time."

What a brilliant answer. I will be going back there. They all seemed really happy when I complimented them on their great service too.

Goes to show, you can learn a lesson from anybody.

Alternatives

To all us paramedic types: Who hasn't arrived at a patient to find out their call was not appropriate for the ambulance service? Thought so!

Two things I would like to discuss:
One: Alternatives. In the area where I work there aren't too many. A lot of GP clinics don't take new patients, the standard of treatment can be very average. At night time, getting hold of a GP is even trickier, heading towards impossible. Out of hospital services (hospital at home, nurse practitioners) are just in their infancy and not widely spread. Paramedic practitioners do not exist, and judging by the current environment it may be quite some time until they do arrive (if at all).
Point being: a lot of the times people don't know where to turn to, so they just call an ambulance. You might be their only choice.
Two: Due to the above, it has become a mindset to call an ambulance. Not only for transport, but for advice on the current situation. Unfortunately, not much of our training is directed towards advice, neither are our guidelines. (You come? Hop on! You stay? Sign here!)
BUT - This is the very situation where we have the chance to change things and show the public that we a professionals, and not mere transport monkeys.
That 13year old girl with 'DIB/SOB' (difficulty in breathing, shortness of breath) due to a massive asthma attack who gets a lights and sirens response? Yep, on arrival she has a cold, nothing more, but thats part of the job. Sure, her mum may have exaggerated over the phone to get us there quicker, she also may have unintentionally said all the right keywords (AMPDS or not). Either way both of them should be told (not told off) when to dial 000/112/999/911, and when not. The next time they don't call you at 3am for a manflu you may not know it, but you or a colleague will be thankful for one call less that night...
I know there is no easy fix. There will always be people who will call an ambulance for the most minor of ailments, no matter how much you hit them on the head with a sledgehammer educate them. On the other side of the fence, people will still continue to ignore chest pains and refuse ambulance transport although their need is more than genuine. We can't do much about these extremes...but for all cases in between, it's not only up to the system to educate people how to use the service correctly, it's up to us. We are part of the system, after all!

So, what can we do? We should familiarise ourselves with alternative healthcare pathways, pass on this information to patients who may potentially benefit from such and encourage them to use them - appropriately. Talk to the staff at your local hospital what they might know, and find out what they tell people who self present to ED. Browse the net, especially the government websites (aged & disability care), additionally any private healthcare providers who may work closely with the government to provide a service.

- ~ -

Feedback please! Let me know how you deal with such situations, what alternative pathways you have, and any improvements (both ambulance and hospital) that have been implemented in your area.


P.S.: Thanks to Ross Hendry (twitter: @ross71521) for pointing out that The Happy Medic wrote a similarly themed blog post recently: http://bit.ly/cwHIUc

My Folder

My Folder.

Comes with me to every job, gets to know all my patient details, get flung around in the back of the van, falls on the floor, spills its contents around, only to be picked up by an angry owner (me) and getting shoved back together in one place. It's predecessor was green (funky!), but sadly died a slow death of maltreatment. Everyday office folders aren't made for everyday ambulance abuse I guess.

Anyway, point to be made is the content. Have a look at the inside sleeve, that's my main reminder of what I want to write on my Patient Care Record form, on the other side is a quick trauma assessment sheet.

This is the Main Page:

Crafted and finetuned after 15 months of experience (with hopefully many more years to come!), continually added information as experience expands, this is the heart and sole of my paperwork. Generally the procedure consists of doing a job, documenting as much as possible and needed, handing over at hospital, remembering questions that I had no answer for (I once forgot to check for a tonguebite and incontinence in a seizure patient). These improvements make their way on to the sheet, which eventually make their way in to my brain, sheet more of a backup plan for doozy days or 3am jobs. Only recently (3-4 weeks ago) did I add the OPQRST to my repertoire, which has made Chest Pain and Abdo Pain calls much easier, asking the right questions and getting the documentation right the first time.

To keep posts short (yep Taz, this is for you :), I'll divide my folder explanation up in to two posts.

What do you guys carry around in your folder? Any tips/tricks/hints I could add?

Feel free to use my template (please don't forget to credit me). I can send you a PDF/word/pages version of the document if you like, just let me know in the comments (can only upload pics to blogger).