The Only Thing That Matters Is the patient in front of you

[iamyourgod]

I see so many questions with the common underlying problem, " I am on scene with this drunk, this crazy person, this system abuser, this non-emergency, this DNR" -- how can i get out of transporting them, or why should i have to tie up my ALS unit with this. The answer is that the only thing that matters is the patient in front of you. As a paramedic it is not your responsibility to plan, budget, or deploy enough ambulances to cover peak call volume. When you start leaving these patients behind so that you can get 10-8 for the real emergency, you will get yourself burned. You do not have the lab or radiological equipment necessary to rule out all possibilities of illness/injury. Do your job and take care of your patient.

[emtannie]

I agree with your post... however, the problem lies much deeper than this.

There are always (unfortunately) those EMS staff who only want to do the "glory" calls, and don't want to do the run of the mill calls. We have to educate these members that their job includes every patient.

There is also a breakdown in education in a lot of paramedic programs where students don't get enough background in psychology or mental helath issues, or dealing with substance abuse. Dealing with a drunk isn't my favorite call either, but if I can try to look past the surface problem - the patient's drinking - and try to look deeper, I find I am usually more understanding.

You are right - it isn't the medic's problem to budget, plan or deploy units during peak times. It is the medic's responsibility to use time wisely and not be on scene longer than necessary, and return to service most efficiently. Sometimes that becomes an issue of not providing good care when it is the frequent flyer that you have had 4 times this week, and yes, you are tired of seeing them, and rather than being the patient advocate for more in hospital care, you get the run done as quickly as possible and leave them in the ER, hoping that someone else will deal with them. I'm not saying it is right, I am saying that is what happens.

In smaller services, there is also the publicity. Notice how whenever a unit is unavailable for a critical call, it isn't the service that gets hacked in the news, it is the medics themselves? This is also something that needs to be addressed. I have been in numerous situations where public citizens have addressed me personally regarding issues of coverage.. and I refer them to my supervisor to lodge their concerns to the right person. They don't want to talk to the person in the office - they want to talk to, and about, the person they see - the medic on the street...

So, althought I agree with your post, it only scratches the surface. Solving the issue is a lot deeper than "focus on your patient."

[iamyourgod]

I appreciate the feedback, but as i stated, once you start digging into solving the problem, people tend to lose focus on what is important, and that is the patient in front of them. And although the field paramedic may catch most of the abuse, it is not their problem to solve. This post was about clarifying the medic on the scene's role, which shouldnt be anything other than "what is best for the patient in front of me now". How many times have you seen someone get a refusal because it was 3am or because dinner was getting cold back at the station or in the truck, or because the patient wanted to go to a hospital that was too far away. You could make the same excuse for ER nurses having to deal with non-emergent patients in the ER. We can argue all day about whether they should be there or not, or how we can fix the "health care problem", but it is that nurse's duty to provide the best care to that patient, and not make excuses as to why he/she should be able to provide a lower standard of care.

[DwayneEMTP]

Man, you sound really angry....

I agree with you, and disagree with you. It's not the medics problem to solve while on scene, but it is absolutely the medics problem to solve while not, the same way nurses unite to resolve nursing issues and Dr.s unite to resolve doctor issues.

If EMS is going to grow as a profession, which you keep mentioning in your posts, professionalism, then they need to be active, have an intelligent opinion, help formulate a plans, and help promote resolutions. It's really not that difficult to spout off about pt advocacy and compassion, it's much different when those opinions commit you to taking action, which takes time.

I've read two other of your posts, and I definately get the feeling that you've come here to lecture to the ignorant. There are plenty of ignorant in EMS, but this isn't the best place if you wish to spout off in stead of discuss.

Welcome to the City. I look forward to your thoughts.

Dwayne

[scott33]

but it is that nurse's duty to provide the best care to that patient, and not make excuses as to why he/she should be able to provide a lower standard of care.

It is also a nurse's duty to educate their patients, and that sometimes includes tactfully getting the point across to known time wasters, that they are abusing the system.

[iamyourgod]

I am not angry, but I am an EMS GOD, so my tone may sound condescending --LOL ---- I love the phrase "Responsibility to Educate", funny though, it is only used when it gets an EMT/Medic out of transporting a patient.

[emtannie]

I appreciate the feedback, but as i stated, once you start digging into solving the problem, people tend to lose focus on what is important, and that is the patient in front of them. And although the field paramedic may catch most of the abuse, it is not their problem to solve. This post was about clarifying the medic on the scene's role, which shouldnt be anything other than "what is best for the patient in front of me now". How many times have you seen someone get a refusal because it was 3am or because dinner was getting cold back at the station or in the truck, or because the patient wanted to go to a hospital that was too far away. You could make the same excuse for ER nurses having to deal with non-emergent patients in the ER. We can argue all day about whether they should be there or not, or how we can fix the "health care problem", but it is that nurse's duty to provide the best care to that patient, and not make excuses as to why he/she should be able to provide a lower standard of care.

It isn't losing focus to look at the whole picture - yes, at the moment, that patient is your priority... but there is still a big picture. We have to look at how to provide quality, yet efficient service.

At no time did I say we should provide less care... or provide poorer quality service. I gave reasons as to why medics get frustrated, and how we should be looking at the whole picture, and solving the issue. And yes, "fixing health care" is exactly what we should be doing. If we are not constantly striving to improve, we are part of the problem.

As I tell my staff... I don't have a problem with complaining... but if you are going to complain about something, also provide a possible viable solution - this makes staff accountable for their complaints, and they find out that complaining for the sake of complaining gets them nowhere. If they see a problem, part of their job is to be part of the solution.

[Eydawn]

Yes, you have a duty to the patient in front of you. No arguments here. You also have a duty to ensure that you provide proper feedback both to your patients and to your management in order to provide ground-level intelligence as to how to provide the best coverage. If you're consistently tied up with one frequent flier, or 7 frequent fliers, and care of acute patients is suffering in your area, you shouldn't just shut up and deal because you have an obligation only to the patient in front of you.

I agree that we spend way too much time bitching about or not providing adequate care to indigents, lower acuity level calls... but it's because on some level, many of us are frustrated with being tied up when our care is needed elsewhere.

Any suggestions for solving the problem? More staffing in your area? A "hobo" van to transport them somewhere?

Wendy

CO EMT-B

[emtannie]

I am not angry, but I am an EMS GOD, so my tone may sound condescending --LOL ---- I love the phrase "Responsibility to Educate", funny though, it is only used when it gets an EMT/Medic out of transporting a patient.

Hmmmm.... I just saw your last post when I submitted mine.....

I have checked your profile, which gives no information on you. A little background into what exactly makes you an "EMS GOD" and why anyone here should consider you such would be appreciated. What is your education and experience background? What is your management and supervisory background?

Being condescending will not improve discussion.

I would also caution you against making a blanket comment like "I love the phrase "Responsibility to Educate", funny though, it is only used when it gets an EMT/Medic out of transporting a patient." I would like for you to take some time and browse through the forums, and the discussions on quality education and the need to improve education, and take note of the number of high quality educators on this site. I think you will find that there is not any support for your comment as using that as an excuse to not transport a patient is definitely not what we are striving for.

Although this site is welcoming to open debate on topics, and at times the discussion can be heated, I hope that your basis for opinions stems from more substance than "I am an ems god." Give rationale for your opinons, and it will make knowledgeable discussion easier.

[iamyourgod]

great point (and if you havent noticed, there is a "discussion" happening). I too subscribe to your theory, and do believe that everyone in the organization should be involved in making their system the best that they can. But even if you increased your fleet by 10-30%, you would still have one of those days when the amount of ambulances you have is not enough. We have all had those days where the calls just kept coming. All I am saying is that when you are in front of that patient, you shouldnt sacrifice their care because you are down to one ALS truck, or out of trucks all together. The patients I initially listed by category, are the exact ones that medics always get in trouble for not transporting.